Individual results
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
0
|
1
|
0
|
NA
|
NA
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
0
|
0
|
0
|
NA
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
1
|
1
|
0
|
NA
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
NA
|
NA
|
1
|
1
|
0
|
0
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
1
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
NA
|
NA
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
1
|
1
|
0
|
NA
|
NA
|
NA
|
0
|
LLM response
24 quote(s) from
publication full text (mean similarity 98.7%)
A1
Quote: "We performed a systematic review to examine the effectiveness of surgical interventions to treat obese children and adolescents, and whether they are cost-effective."
Reasoning: The research question and inclusion criteria were established before conducting the review.
[Yes]
A2
Quotes: "Searches were conducted in PubMed, Embase, ISI Web of Science and the Cochrane Library to 6 September 2010, and hand-searched bibliographies. We included articles with English abstracts if they examined subjects aged ≤19 years of age, reported at least one postoperative weight loss measure and at least 1 year of postoperative follow-up."
Reasoning: At least two databases were searched and bibliographies were hand-searched.
[Yes]
A3
Quotes: "Searches were conducted in PubMed, Embase, ISI Web of Science and the Cochrane Library to 6 September 2010, and hand-searched bibliographies. We included articles with English abstracts if they examined subjects aged ≤19 years of age, reported at least one postoperative weight loss measure and at least 1 year of postoperative follow-up."
Reasoning: Multiple databases were searched and bibliographies were hand-searched. Inclusion criteria are stated.
[Yes]
A4
Quote: "We included articles with English abstracts if they examined subjects aged ≤19 years of age, reported at least one postoperative weight loss measure and at least 1 year of postoperative follow-up."
Reasoning: Only articles with English abstracts were included, suggesting publication status was used as an inclusion criterion.
[Yes]
A5
Quote: "Refer to flow diagram in Appendix 2."
Reasoning: A flow diagram of included and excluded studies is provided in Appendix 2.
[Yes]
A6
Quotes: "Thirty-seven relevant papers on bariatric surgery effectiveness in 831 children or adolescents were included, spanning 36 years. Thirteen studies examined gastric banding, with mean body mass index (BMI) reductions ranging from 8.5 to 43 kg m−2."
"All but two papers (35,43) described baseline comorbid conditions, which included amenorrhea, depression, dyslipidaemia, hypertension, insulin resistance, metabolic syndrome, orthopaedic problems, osteoarthritis, sleep apnoea and type 2 diabetes."
Reasoning: Aggregate data on participant characteristics, interventions and outcomes are provided.
[Yes]
A7
Quotes: "We included articles with English abstracts if they examined subjects aged ≤19 years of age, reported at least one postoperative weight loss measure and at least 1 year of postoperative follow-up."
"Existing evidence – although based generally on underpowered, retrospective studies – suggests that bariatric surgery in older children results in significant weight loss and improvements in comorbidities and quality of life."
Reasoning: Inclusion criteria are stated and the quality of included studies is discussed narratively, but no formal quality assessment is reported.
[No]
A8
[NA] - No formal quality assessment was conducted, so this item is not applicable.
A9
[NA] - No meta-analysis was conducted, so assessing the appropriateness of methods for combining studies is not applicable.
A10
[NA] - No meta-analysis was conducted, so assessing publication bias is not applicable.
A11
Quote: "The project that led to this paper was funded by the WHO Health Evidence Network of the World Health Organization. The funder had no role in the design, analysis or interpretation of the study. The views expressed are those of the authors and do not necessarily reflect the position of the funding body."
Reasoning: Sources of support for the systematic review are acknowledged, but sources of support for the included studies are not reported.
[No]
P1
Quote: "Effectiveness and cost-effectiveness of paediatric bariatric surgery: a systematic review"
Reasoning: The title identifies the article as a systematic review.
[Yes]
P2
Quote: See the structured abstract on page 1 of the full text PDF.
Reasoning: A structured abstract with labeled sections is provided.
[Yes]
P3
Quote: "Despite reports of levelling off in some countries (1–3), childhood obesity and its associated morbidities and costs are considerable and increasing in scale in many countries (4,5), particularly among socioeconomically disadvantaged segments of many populations (6). Obese children and adolescents are more likely than their normal weight peers to suffer endocrine, cardiovascular, pulmonary, orthopaedic, psychosocial and other complications associated with excessive weight, many of which persist into adulthood (7–9)."
Reasoning: The rationale for the review is described in the context of the increasing prevalence and health consequences of childhood obesity.
[Yes]
P4
Quote: "We performed a systematic review to examine the effectiveness of surgical interventions to treat obese children and adolescents, and whether they are cost-effective."
Reasoning: The research questions are explicitly stated, referencing the population (obese children and adolescents), intervention (surgical interventions), and outcomes of interest (effectiveness and cost-effectiveness).
[Yes]
P5
[No] - No mention of a review protocol or registration number.
P6
Quotes: "We included articles with English abstracts if they examined subjects aged ≤19 years of age, reported at least one postoperative weight loss measure and at least 1 year of postoperative follow-up."
"At least one postoperative weight loss measure had to be reported, with a minimum follow-up time of 1 year post surgery."
Reasoning: Eligibility criteria for study characteristics (population, intervention, outcomes, follow-up duration) and report characteristics (English abstracts) are specified.
[Yes]
P7
Quote: "Searches were conducted in PubMed, Embase, ISI Web of Science and the Cochrane Library to 6 September 2010, and hand-searched bibliographies."
Reasoning: Information sources (databases with search end date and bibliography searching) are described.
[Yes]
P8
Quotes: "Appendix 1 contains details of the search terms."
"1a. PubMed search terms
#1. obes*[TIAB] OR overweight*[TIAB] OR weight loss[TIAB] OR weight reduc*[TIAB] OR BMI[TIAB] = 172 843
#2. child[TIAB] OR children[TIAB] OR adolescen*[TIAB] OR pediatr*[TIAB] OR paediatr*[TIAB] = 909 583
#3. bariatric[TIAB] OR gastric surgery[TIAB] OR gastroplasty[TIAB] OR gastrectomy[TIAB] OR gastric bypass[TIAB] OR jejunoileal bypass[TIAB] OR gastrointestinal diversion[TIAB] OR gastrointestinal surgery[TIAB] OR biliopancreatic diversion[TIAB] OR biliopancreatic bypass[TIAB] OR gastric band*[TIAB] OR gastrectomy[TIAB] OR LAGB[TIAB] OR stomach stapl*[TIAB] OR lap band*[TIAB] OR lapband*[TIAB] OR roux-en-y[TIAB] OR malabsorptive surgery[TIAB] OR restrictive surgery[TIAB] OR restrictive procedure[TIAB] OR duodenal switch[TIAB] OR antiobesity surgery[TIAB] OR weight loss surgery[TIAB] OR weight reduction surgery[TIAB] OR surgery[TIAB] OR surgical[TIAB] = 973 334
#4. #1 AND #2 AND #3 = 950"
Reasoning: The full electronic search strategy is provided for PubMed.
[Yes]
P9
Quote: "Refer to flow diagram in Appendix 2."
Reasoning: The study selection process is illustrated in a flow diagram.
[Yes]
P10
[No] - The method of data extraction is not described.
P11
[No] - Variables for which data were sought are not explicitly defined.
P12
[No] - Methods for assessing risk of bias in individual studies are not described.
P13
[NA] - No meta-analysis was conducted, so summary measures are not applicable.
P14
[NA] - No meta-analysis was conducted.
P15
[NA] - No meta-analysis was conducted, so assessing risk of bias across studies is not applicable.
P16
[NA] - No additional analyses were reported.
P17
Quote: "Refer to flow diagram in Appendix 2."
Reasoning: A flow diagram illustrating the number of studies screened, assessed for eligibility, included and excluded with reasons is provided.
[Yes]
P18
Quote: "Appendix 3, Table A1"
Reasoning: Study characteristics including country, study type, sample size, follow-up duration, baseline BMI, postop BMI, and whether comorbidities were measured are provided for each included study in Table A1.
[Yes]
P19
[No] - Risk of bias assessments for individual studies are not presented.
P20
[No] - Results for individual studies are not fully reported. Effect estimates and confidence intervals are lacking.
P21
[NA] - No meta-analysis was conducted.
P22
[NA] - No meta-analysis was conducted, so reporting results of risk of bias assessment across studies is not applicable.
P23
[NA] - No additional analyses were reported.
P24
Quote: "Thirty-seven relevant papers on bariatric surgery effectiveness in 831 children or adolescents were included, spanning 36 years. This review serves to update an early systematic review on the topic by Treadwell et al. in 2008 (33), including case studies with less than three patients (n = 11) and 14 articles published after the December 2007 cut-off used by Treadwell et al."
Reasoning: The main findings are summarized, including the number of studies, total participants, and key results in relation to a previous review.
[Yes]
P25
Quotes: "Existing evidence – although based generally on underpowered, retrospective studies – suggests that bariatric surgery in older children results in significant weight loss and improvements in comorbidities and quality of life."
"Results were not broadly comparable given a lack of consistency across surgeons, procedures and reported outcomes."
"Accurate information for low frequency outcomes like mortality and complications was sparse."
"No studies on clinical effectiveness reported on costs, and only one study addressed bariatric surgery cost in children."
Reasoning: Limitations at the study level (underpowered retrospective studies), outcome level (lack of comparability) and review level (sparse data on rare outcomes, lack of cost data) are discussed.
[Yes]
P26
Quote: "Bariatric surgery is promoted as a treatment option for children and adolescents for several reasons as outlined above, but these also generate some controversy. Proponents in the surgical community suggest that the procedure is justified by weight loss results from clinical trials in adults, and should form part of a multidisciplinary paediatric weight management strategy to address life-threatening comorbidities seen in morbidly obese children. They add that delaying treatment and allowing comorbid conditions to progress could be equally or more disadvantageous, and that in practice, most adult bariatric centres already perform adolescent surgery (73). It is argued that, in principle, treatment risks are accepted when the benefits of treatment outweigh the risks of withholding treatment, and that the use of bariatric surgery in paediatric weight management should be seen as an extension of age-related, i.e. when the risks of chronic comorbidities should outweigh the risks of surgery for patients at any age."
Reasoning: The results are interpreted in the context of the rationale for bariatric surgery in youth and the risks and benefits at different ages. Implications for practice are discussed.
[Yes]
P27
Quote: "The project that led to this paper was funded by the WHO Health Evidence Network of the World Health Organization. The funder had no role in the design, analysis or interpretation of the study. The views expressed are those of the authors and do not necessarily reflect the position of the funding body."
Reasoning: Sources of funding for the systematic review are described and the role of the funder is made explicit.
[Yes]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
0
|
0
|
1
|
0
|
0
|
1
|
1
|
1
|
0
|
NA
|
NA
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
0
|
0
|
0
|
1
|
0
|
0
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
0
|
1
|
0
|
NA
|
NA
|
NA
|
NA
|
0
|
1
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
NA
|
NA
|
0
|
0
|
0
|
1
|
NA
|
NA
|
NA
|
0
|
0
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
1
|
0
|
0
|
1
|
0
|
0
|
NA
|
NA
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
0
|
1
|
0
|
0
|
1
|
0
|
0
|
NA
|
NA
|
0
|
LLM response
23 quote(s) from
publication full text (mean similarity 98.9%)
A1. Was an 'a priori' design provided?
Quotes: None relevant.
Reasoning: No mention of a protocol, ethics approval, or a priori objectives.
[No]
A2. Was there duplicate study selection and data extraction?
Quotes: "A data extraction form was created to standardize the collection of study elements from each included article. This form included the following information: inclusion/exclusion criteria, study title, author, characteristics of the journal (year of publication), study design, study period, sample size, and the focus of the study in use of the LAARP as a primary procedure or after colostomy."
Reasoning: Data extraction was standardized but no mention of it being done in duplicate.
[No]
A3. Was a comprehensive literature search performed?
Quotes: "A systematic search of the MEDLINE, PUBMED, and Cochrane databases (June 2000 to April 2008) was conducted. The search terms used were "laparoscopic," "pull-through," "anorectal malformation," and "imperforate anus." In addition, a manual search of 4 surgical journals from the same period was performed. The journals searched were "The Journal of Pediatric Surgery," "Pediatric Surgery International," "Surgical Endoscopy," and "Journal of Laparoendoscopic & Advanced Surgical Techniques.""
Reasoning: At least 2 databases plus manual search of journals were used.
[Yes]
A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion?
Quotes: None relevant.
Reasoning: No mention of including grey literature or unpublished studies.
[No]
A5. Was a list of studies (included and excluded) provided?
Quotes: None relevant.
Reasoning: No list of included or excluded studies provided.
[No]
A6. Were the characteristics of the included studies provided?
Quotes: "The studies included 124 patients—96 males (77.4%) and 28 females (22.6%). Of the 124 patients, 110 (88.7%) had undergone previous colostomy, whereas 14 patients (11.2%) had undergone a primary laparoscopic repair without a colostomy. Most patients (80%) had either a high or intermediate ARM."
Reasoning: Aggregate characteristics of patients from included studies were provided.
[Yes]
A7. Was the scientific quality of the included studies assessed and documented?
Quotes: "Analysis of study designs revealed 2 prospective studies (11.7%) [2,3], 4 comparative studies (23.5%) [2,4–6], and no randomized studies."
Reasoning: Study designs were assessed but no formal quality assessment was performed.
[No]
A8. Was the scientific quality of the included studies used appropriately in formulating conclusions?
Quotes: "One in 5000 infants is born with an ARM. The evolution of surgical techniques for dealing with this complex group of malformations led to the description of the PSARP by deVries and Pena [18] in 1982. Posterior sagittal anorectoplasty quickly became the standard of care for dealing with ARM. Despite the excellent exposure of anatomy and exact placement of the distal rectum within the muscle complex, the technique is not perfect, especially in patients with "high" ARM defects [19–21]."
Reasoning: The limitations of the included studies were not considered when formulating conclusions.
[No]
A9. Were the methods used to combine the findings of studies appropriate?
Quotes: None relevant.
Reasoning: This was a systematic review without a meta-analysis, so no combining of study findings was performed.
[NA]
A10. Was the likelihood of publication bias assessed?
Quotes: None relevant.
Reasoning: No assessment of publication bias was mentioned.
[NA]
A11. Was the conflict of interest included?
Quotes: None relevant.
Reasoning: No disclosure of funding sources or conflicts of interest for the systematic review or included studies.
[No]
P1. Title: Identify the report as a systematic review, meta-analysis, or both.
Quote: "Laparoscopic-assisted anorectal pull-through for anorectal malformations: a systematic review and the need for standardization of outcome reporting"
Reasoning: The title identifies the article as a systematic review.
[Yes]
P2. Abstract / Structured summary
Quote: The abstract contains labeled sections for Introduction, Methods, Results, and Conclusion.
Reasoning: The abstract is structured with distinct sections.
[Yes]
P3. Introduction / Rationale
Quote: "Over the past several years, techniques have evolved in the repair of high and intermediate anorectal malformations (ARMs), starting with the abdominoperineal pull-through, sacroperineal pull-through, and posterior sagittal anorectoplasty (PSARP) and now moving toward the recently reported laparoscopically assisted anorectal pull-through (LAARP) procedure."
Reasoning: Provides rationale for the review in the context of the evolution of ARM repair techniques.
[Yes]
P4. Introduction / Objectives
Quote: "The aim of this review was to conduct a systematic review to evaluate the worldwide experience with LAARP with regard to indications, outcomes, and quality of reporting in published articles."
Reasoning: Explicitly states the objectives of the review.
[Yes]
P5. Methods / Protocol and registration
Quotes: None relevant.
Reasoning: No mention of a review protocol or registration number.
[No]
P6. Methods / Eligibility criteria
Quote: "Inclusion criteria were studies of ARMs, regardless of level of the defect, with or without associated anomalies, use of LAARP as a primary procedure or with colostomy, and studies reported after the year 2000. Exclusion criteria included studies that were not reported in English and those that did not deal with human subjects."
Reasoning: Eligibility criteria for included studies are specified.
[Yes]
P7. Methods / Information sources
Quote: "A systematic search of the MEDLINE, PUBMED, and Cochrane databases (June 2000 to April 2008) was conducted" [...] "In addition, a manual search of 4 surgical journals from the same period was performed."
Reasoning: Databases searched and date ranges are provided.
[Yes]
P8. Methods / Search
Quote: "The search terms used were "laparoscopic," "pull-through," "anorectal malformation," and "imperforate anus.""
Reasoning: Search terms are provided but full search strategy is not reported.
[No]
P9. Methods / Study selection
Quote: "Only studies published in full were included."
Reasoning: Minimal details on the study selection process are provided.
[No]
P10. Methods / Data collection process
Quote: "A data extraction form was created to standardize the collection of study elements from each included article."
Reasoning: A standardized data extraction form was used but no mention of the process being piloted or done in duplicate.
[No]
P11. Methods / Data items
Quote: "This form included the following information: inclusion/exclusion criteria, study title, author, characteristics of the journal (year of publication), study design, study period, sample size, and the focus of the study in use of the LAARP as a primary procedure or after colostomy."
Reasoning: The data items collected are listed.
[Yes]
P12. Methods / Risk of bias in individual studies
Quotes: None relevant.
Reasoning: No assessment of risk of bias in individual studies was mentioned.
[No]
P13. Methods / Summary measures
Quotes: None relevant.
Reasoning: No principal summary measures were specified.
[No]
P14. Methods / Synthesis of results
Quotes: None relevant.
Reasoning: No meta-analysis was performed in this review.
[NA]
P15. Methods / Risk of bias across studies
Quotes: None relevant.
Reasoning: No assessment of risk of bias across studies was mentioned.
[NA]
P16. Methods / Additional analyses
Quotes: None relevant.
Reasoning: No additional analyses were mentioned.
[NA]
P17. Results / Study selection
Quote: "Seventeen studies were included in the final analysis. Of the included studies, none were randomized, 2 were prospective in nature, and 4 compared outcomes of posterior sagittal anorectoplasty and LAARP. The studies included 124 patients (96 males, 28 females) with 80% reported as having high/intermediate malformations."
Reasoning: The number of included studies and reasons for exclusions are provided, but no flow diagram is included.
[No]
P18. Results / Study characteristics
Quote: "The studies included 124 patients—96 males (77.4%) and 28 females (22.6%). Of the 124 patients, 110 (88.7%) had undergone previous colostomy, whereas 14 patients (11.2%) had undergone a primary laparoscopic repair without a colostomy. Most patients (80%) had either a high or intermediate ARM."
Reasoning: Aggregate characteristics of the included studies are provided but not for each individual study.
[No]
P19. Results / Risk of bias within studies
Quotes: None relevant.
Reasoning: No assessment of risk of bias within individual studies was reported.
[No]
P20. Results / Results of individual studies
Quotes: See Table 4 which summarizes key characteristics and outcomes from 4 comparative studies.
Reasoning: For a subset of studies, outcome data and follow-up periods are provided for each study group.
[Yes]
P21. Results / Synthesis of results
Quotes: None relevant.
Reasoning: No meta-analysis was performed.
[NA]
P22. Results / Risk of bias across studies
Quotes: None relevant.
Reasoning: No assessment of risk of bias across studies was reported.
[NA]
P23. Results / Additional analysis
Quotes: None relevant.
Reasoning: No additional analyses were reported.
[NA]
P24. Discussion / Summary of evidence
Quote: "One in 5000 infants is born with an ARM. The evolution of surgical techniques for dealing with this complex group of malformations led to the description of the PSARP by deVries and Pena [18] in 1982. Posterior sagittal anorectoplasty quickly became the standard of care for dealing with ARM. Despite the excellent exposure of anatomy and exact placement of the distal rectum within the muscle complex, the technique is not perfect, especially in patients with "high" ARM defects [19–21]."
Reasoning: Key findings are summarized but strength of evidence is not explicitly stated.
[No]
P25. Discussion / Limitations
Quote: "As a result, widespread adoption of the LAARP by the pediatric surgery community has taken place in recent years. Perceived advantages of LAARP include excellent visualization of the rectal fistula and accurate placement of the pull-through segment at the center of the levator sling without dividing the muscles that control continence, which is an inevitability of PSARP."
Reasoning: Advantages of LAARP are discussed but limitations of the review itself are not addressed.
[No]
P26. Discussion / Conclusions
Quote: "In conjunction with the increased interest in minimal access surgery in children, there has been increased awareness among surgeons of the importance of evidence-based surgery."
Reasoning: A general conclusion is provided in the context of the need for evidence-based surgery in pediatrics.
[Yes]
P27. Funding
Quotes: None relevant.
Reasoning: No sources of funding or support are reported.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
1
|
0
|
0
|
1
|
0
|
NA
|
NA
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
0
|
1
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
0
|
1
|
0
|
NA
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
NA
|
NA
|
0
|
1
|
0
|
1
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
0
|
0
|
0
|
1
|
0
|
0
|
NA
|
NA
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
NA
|
NA
|
NA
|
0
|
LLM response
15 quote(s) from
publication full text (mean similarity 92.7%)
A1 - Protocol/a priori design:
Quote: "We reviewed our experience and performed a systematic review of reports of EDT in pediatric patients."
Reasoning: No mention of a protocol or a priori design.
[No]
A2 - Duplicate study selection and data extraction:
No relevant quotes found.
Reasoning: No mention of duplicate study selection or data extraction.
[No]
A3 - Comprehensive literature search:
Quote: "We reviewed our experience and performed a systematic review of all published reports of EDT in pediatric patients."
Reasoning: Only mentions reviewing published reports, no details on databases, keywords, or supplementary strategies.
[No]
A4 - Grey literature as inclusion criterion:
No relevant quotes found.
Reasoning: No mention of including grey literature.
[No]
A5 - List of included and excluded studies:
No relevant quotes found.
Reasoning: No list of included or excluded studies provided.
[No]
A6 - Characteristics of included studies:
Quote: "These reports obtained from a Medline search and our publications regarding EDT in the pediatric population for the past 40 year using the keywords "thoracotomy", "emergency", "trauma", "resuscitation", "pediatrics", and "children"."
Reasoning: Some study characteristics are mentioned but not provided in an aggregated form like a table.
[No]
A7 - Quality assessment of included studies:
No relevant quotes found.
Reasoning: No mention of assessing quality or risk of bias of included studies.
[No]
A8 - Quality used appropriately in conclusions:
No relevant quotes found.
Reasoning: Quality not assessed (A7), so cannot be used in conclusions.
[NA]
A9 - Appropriate methods to combine studies:
Quote: "To minimize variability by each series, to minimize the effect of outliers, and to allow for generalizations to be made. Selection bias may have also affected results, as all EDT were performed at the discretion of the trauma physician."
Reasoning: Mentions variability between studies but no statistical test for heterogeneity. No meta-analysis performed.
[NA]
A10 - Publication bias assessed:
No relevant quotes found.
Reasoning: No assessment of publication bias. No meta-analysis performed.
[NA]
A11 - Conflicts of interest stated:
No relevant quotes found.
Reasoning: No mention of funding sources or conflicts of interest.
[No]
P1 - Title identifies as systematic review/meta-analysis:
Quote: "Pediatric emergency department thoracotomy: A large case series and systematic review"
Reasoning: Title clearly identifies the article as a systematic review.
[Yes]
P2 - Structured abstract:
Quote: The abstract contains labeled sections for Background/purpose, Methods, Results, and Conclusion.
Reasoning: The abstract is structured with distinct labeled sections.
[Yes]
P3 - Rationale:
Quote: "Trauma remains the leading cause of morbidity and mortality in children and adolescents [1,2]. By recognizing this, care of the injured child has improved with aggressive efforts to standardize treatment."
Reasoning: Provides rationale for the review in the context of the importance of pediatric trauma care.
[Yes]
P4 - Objectives:
Quote: "To address this issue, we reviewed our experience at a level 1 trauma center and report the largest analysis over the past 25 years. In conjunction, we performed a systematic review of all published reports regarding pediatric EDT and combined the data from those reports with the data from our institution"
Reasoning: Clearly states the objectives of reviewing their experience and systematically reviewing the literature on pediatric EDT.
[Yes]
P5 - Protocol/registration:
No relevant quotes found.
Reasoning: No mention of a protocol or registration number.
[No]
P6 - Eligibility criteria:
Quote: "These reports obtained from a Medline search and our publications regarding EDT in the pediatric population for the past 40 year using the keywords "thoracotomy", "emergency", "trauma", "resuscitation", "pediatrics", and "children". Bibliographies of relevant publications were reviewed to identify reports that were not initially located with the Medline search."
Reasoning: Describes the inclusion criteria of pediatric EDT publications in the past 40 years identified through a Medline search and bibliography review.
[Yes]
P7 - Information sources:
Quote: "These reports obtained from a Medline search and our publications regarding EDT in the pediatric population for the past 40 year using the keywords "thoracotomy", "emergency", "trauma", "resuscitation", "pediatrics", and "children". Bibliographies of relevant publications were reviewed to identify reports that were not initially located with the Medline search."
Reasoning: States that Medline and bibliography searching were used, but no dates of coverage provided.
[Yes]
P8 - Search:
Quote: "These reports obtained from a Medline search and our publications regarding EDT in the pediatric population for the past 40 year using the keywords "thoracotomy", "emergency", "trauma", "resuscitation", "pediatrics", and "children"."
Reasoning: Keywords are provided but not the full search strategy for replication.
[No]
P9 - Study selection:
Quote: "These reports obtained from a Medline search and our publications regarding EDT in the pediatric population for the past 40 year using the keywords "thoracotomy", "emergency", "trauma", "resuscitation", "pediatrics", and "children". Bibliographies of relevant publications were reviewed to identify reports that were not initially located with the Medline search."
Reasoning: Describes the process for identifying relevant studies through Medline searching and bibliography review.
[Yes]
P10 - Data collection process:
Quote: "For publications that did not report certain variables, those cases were systematically excluded when analyzing that missing variable."
Reasoning: Mentions that cases with missing data were excluded from certain analyses, but no details on how data was extracted.
[No]
P11 - Data items:
Quote: "For publications that did not report certain variables, those cases were systematically excluded when analyzing that missing variable. Although each series differs in the specific data reported, the information obtained was pooled and analyzed using the variables and outcomes reported by each series."
Reasoning: Variables analyzed were those reported in each series, but a list of all variables is not provided.
[No]
P12 - Risk of bias in individual studies:
No relevant quotes found.
Reasoning: No mention of assessing risk of bias in individual studies.
[No]
P13 - Summary measures:
Quote: "MOIs included gunshot wound (GSW) (74%), stab wound (15%), and motor vehicle collision (8%). In the field, 46% had initial VS and 67% had SOL. Upon arrival, 25% had VS and 56% had SOL."
Reasoning: Proportions are presented as the main summary measures.
[Yes]
P14 - Synthesis of results:
No relevant quotes found.
Reasoning: No meta-analysis was performed.
[NA]
P15 - Risk of bias across studies:
No relevant quotes found.
Reasoning: No mention of assessing risk of bias across studies.
[NA]
P16 - Additional analyses:
No relevant quotes found.
Reasoning: No mention of any additional analyses.
[NA]
P17 - Study selection results:
No relevant quotes found.
Reasoning: Numbers of studies screened, excluded, and included are not provided, and no flow diagram is present.
[No]
P18 - Study characteristics:
Quote: Table 1 provides a systematic review of the published case series regarding pediatric EDT along with data from Ryder Trauma Center.
Reasoning: Study characteristics are provided in an aggregated table format with citations.
[Yes]
P19 - Risk of bias within studies:
No relevant quotes found.
Reasoning: Risk of bias assessments for individual studies are not reported.
[No]
P20 - Results of individual studies:
Quote: Fig. 1 shows outcomes according to MOI, presence of VS/SOL, and experience of Ryder Trauma Center for each included study.
Reasoning: Forest plots are not provided, but results for individual studies are presented graphically in Fig. 1 and Fig. 2.
[Yes]
P21 - Synthesis of results:
No relevant quotes found.
Reasoning: No meta-analysis was performed.
[NA]
P22 - Risk of bias across studies:
No relevant quotes found.
Reasoning: No assessment of risk of bias across studies was reported.
[NA]
P23 - Additional analyses:
No relevant quotes found.
Reasoning: No additional analyses were reported.
[NA]
P24 - Summary of evidence:
Quote: "Overall, the mortality rates are comparable between adults and pediatric patients following EDT. Children who sustain blunt force trauma and are without SOL at the scene or at their community hospital emergency department. During this development, the resuscitative thoracotomy was also added as an extension to ATLS techniques [19]. Now after 30 years, we are able to systematically review the current literature with this relatively aggressive resuscitative measure in the pediatric population."
Reasoning: Summarizes the main findings on mortality rates and factors associated with outcomes in pediatric EDT.
[Yes]
P25 - Limitations:
Quote: "There are limitations to this study. First, all of the data obtained from our institution were collected retrospectively, and thus not specifically collected for research purposes. As for all data reviewed, some of the variables may have been missing or misclassified. Also, differences in trauma management between physicians and institutions may not allow for generalizations to be made. Selection bias may have also affected results, as all EDT were performed at the discretion of the trauma physician."
Reasoning: Discusses several limitations of the study, including retrospective data collection, missing data, differences in management between centers, and selection bias.
[Yes]
P26 - Conclusions:
Quote: "There is growing interest in the use of a resuscitative endovascular balloon occlusion of the aorta (REBOA) to control hemorrhagic shock in trauma patients. To our knowledge, the REBOA remains a new and still controversial tool. There are limited reports regarding its use in trauma patients. Recently, Brenner et al. tested the technical feasibility of REBOA in adult patients in hemorrhagic shock [25]. Although they concluded it is feasible to use, their technique is during the initial phase of aneurysm. Some believe its main use in trauma could be for placement by emergency medical personnel to temporize a patient prior to transfer to definitive care."
Reasoning: The conclusions discuss the growing interest in and limitations of REBOA as an alternative resuscitative measure to EDT in trauma patients.
[Yes]
P27 - Funding:
No relevant quotes found.
Reasoning: Sources of funding and support are not reported.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
1
|
1
|
0
|
0
|
1
|
1
|
0
|
1
|
1
|
1
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
0
|
NA
|
1
|
1
|
0
|
1
|
1
|
0
|
NA
|
1
|
1
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
NA
|
1
|
0
|
0
|
0
|
1
|
NA
|
NA
|
1
|
1
|
1
|
1
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
1
|
1
|
1
|
0
|
0
|
1
|
1
|
1
|
1
|
0
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
1
|
0
|
0
|
LLM response
26 quote(s) from
publication full text (mean similarity 99.8%)
A1
Quotes: "The review was conducted according to a pre-specified protocol. The protocol was registered on the Prospero International Prospective Register of Systematic Reviews (CRD42012003241)."
Reasoning: The authors state that the review was conducted according to a pre-specified protocol that was registered, indicating an a priori design.
[Yes]
A2
Quotes: "Identified titles were assessed for inclusion by two investigators (BA and WT) acting independently. Any conflicts were resolved by a third investigator (MK). Data from included articles were extracted independently by the same two investigators (BA and WT), and any differences resolved by discussion."
Reasoning: Study selection and data extraction were done independently by two investigators with a process for resolving disagreements.
[Yes]
A3
Quotes: "All study designs except expert opinion were included, and no restrictions were made on the basis of study language or geographical location."
Reasoning: The authors searched multiple databases and did not restrict by language or location, but do not provide full details on the search strategy or supplementary sources.
[No]
A4
Quotes: "All study designs except expert opinion were included, and no restrictions were made on the basis of study language or geographical location."
Reasoning: The authors explicitly state that all study designs except expert opinion were included regardless of publication status.
[Yes]
A5
Quotes: "Using the stated search strategy, 3081 papers were identified. After removal of duplicates, 751 unique articles remained. From this, 8 papers were deemed to meet the inclusion criteria, all of which were cohort studies (Fig. 1). No randomised controlled trials were identified that met the inclusion criteria."
Reasoning: The authors provide the numbers of included and excluded studies with reasons for exclusions at each stage in a flow diagram.
[Yes]
A6
Quotes: "Although reporting of baseline characteristics was variably done by the included studies, where it was reported, there were no statistically significant differences in birth-weight, gestational age, or associated anomalies between the OPFC and SR groups."
Reasoning: Some baseline characteristics of included studies are provided, but in an incomplete and aggregated way.
[No]
A7
Quotes: "Methodological quality and risk of bias were assessed using the STROBE checklist and GRADE criteria."
Reasoning: The authors state the tools used to assess study quality and risk of bias.
[Yes]
A8
Quotes: "Our results would appear to suggest a potential benefit to OPFC over SR. A recently published meta-analysis by Kunz et al [13] agrees with these findings when infants with only simple gastroschisis are included. However, when infants with complex gastroschisis are included in their analysis, they arrive at the conclusion that SR is superior to OPFC. This variation in conclusion highlights one of the key limitations of performing meta-analysis in small specialties. With a lack of standardised populations, interventions or outcome measures, and a scarcity of high quality primary data, inclusion criteria for systematic reviews often have to be more lax than is ideal. This leads to the introduction of significant clinical heterogeneity between the included studies, which may lead to a lack of validity for the conclusions of any meta-analysis."
Reasoning: The authors discuss the quality of included studies when interpreting the results and formulating the conclusions of the review.
[Yes]
A9
Quotes: "Data were synthesized using standard methods as described in the Cochrane Reviewers Handbook [8]. The chi-squared test for heterogeneity was used to assess the extent to which the results of the studies were in agreement. Using a conservative cut-off of p<0.01, no statistical heterogeneity was detected and therefore fixed-effect methods were used throughout. Dichotomous outcomes were meta-analysed using Mantel–Haenszel fixed effects methods to produce summary odds ratios with 95% confidence intervals. Continuous variables were meta-analysed using the inverse-variance fixed-effect method to produce weighted mean differences and 95% confidence intervals."
Reasoning: Appropriate methods were used to assess heterogeneity and synthesize the results.
[Yes]
A10
Quotes: "Although we have attempted to address this potential lack of validity with strict inclusion and exclusion criteria, our conclusion that OPFC is superior to SR must still be tempered by the low quality of the available primary data, and the limitations of our study."
Reasoning: The authors acknowledge the potential impact of publication bias on their conclusions, but do not formally assess it.
[No]
A11
Quotes: "Marian Knight is funded by a National Institute for Health Research Professorship. This article presents independent research partly funded by the National Institute for Health Research (NIHR)."
Reasoning: Sources of support for the systematic review are reported, but sources of support for the included studies are not.
[No]
P1
Quote: "Challenges of Improving the Evidence Base in Smaller Surgical Specialties, as Highlighted by a Systematic Review of Gastroschisis Management"
Reasoning: The title identifies the article as a systematic review.
[Yes]
P2
Quote: See structured abstract with labeled sections including background, methods, results, and conclusions.
Reasoning: The article provides a structured abstract with the specified sections.
[Yes]
P3
Quote: "Gastroschisis is an increasingly common paediatric surgical condition [1], with an incidence in the United Kingdom of approximately 3.5/10000 births [2]. Multiple surgical repair strategies have been developed, which vary based upon whether general anesthesia is used to perform the repair, and whether closure is operative or non-operative [3–6]."
Reasoning: The introduction describes the rationale for the review in the context of what is already known about gastroschisis management strategies.
[Yes]
P4
Quote: "The aim of this study, therefore, was to perform a systematic review of the literature comparing outcomes of infants with simple gastroschisis following either OPFC or SR. From this study we aimed to identify some of the reasons why research in paediatric surgery is currently largely unable to provide a strong evidence base to inform clinical practice."
Reasoning: The introduction states the aim of the systematic review, referencing the population (infants with simple gastroschisis), interventions (OPFC and SR), and outcomes of interest.
[Yes]
P5
Quote: "The review was conducted according to a pre-specified protocol. The protocol was registered on the Prospero International Prospective Register of Systematic Reviews (CRD42012003241)."
Reasoning: The methods state that a review protocol exists and provide its registration number.
[Yes]
P6
Quote: "Studies were included if they involved infants born with simple gastroschisis, defined as gastroschisis with an intact continuous bowel that is not compromised or breached at delivery or presentation. Infants with complex gastroschisis, defined as the presence of at least one of intestinal perforation, necrosis, or atresia were excluded from this review, as they only account for approximately 11.5% of infants with gastroschisis, are known to have a worse prognosis than the majority with simple gastroschisis [2], and thus represent a major confounder in any examination of the outcomes of different management techniques."
Reasoning: The methods specify the study characteristics (participants, interventions) used as eligibility criteria and rationale.
[Yes]
P7
Quote: "All study designs except expert opinion were included, and no restrictions were made on the basis of study language or geographical location."
Reasoning: The information sources are not fully described, lacking specific databases, dates, and the date last searched.
[No]
P8
Quotes: None relevant
Reasoning: The full search strategy is not presented for any database.
[No]
P9
Quote: "Identified titles were assessed for inclusion by two investigators (BA and WT) acting independently. Any conflicts were resolved by a third investigator (MK)."
Reasoning: The process for selecting studies is described.
[Yes]
P10
Quote: "Data from included articles were extracted independently by the same two investigators (BA and WT), and any differences resolved by discussion. Where required, unpublished data were requested from the authors of each of the included studies to allow for meta-analysis."
Reasoning: The method of data extraction is described, including obtaining unpublished data from investigators.
[Yes]
P11
Quotes: None relevant
Reasoning: The data items sought are not explicitly defined.
[No]
P12
Quote: "Methodological quality and risk of bias were assessed using the STROBE checklist and GRADE criteria."
Reasoning: The methods for assessing risk of bias of individual studies are described.
[Yes]
P13
Quotes: "Dichotomous outcomes were meta-analysed using Mantel–Haenszel fixed effects methods to produce summary odds ratios with 95% confidence intervals. Continuous variables were meta-analysed using the inverse-variance fixed-effect method to produce weighted mean differences and 95% confidence intervals."
Reasoning: The principal summary measures (odds ratios, mean differences) are stated.
[Yes]
P14
Quote: "Data were synthesized using standard methods as described in the Cochrane Reviewers Handbook [8]. The chi-squared test for heterogeneity was used to assess the extent to which the results of the studies were in agreement. Using a conservative cut-off of p<0.01, no statistical heterogeneity was detected and therefore fixed-effect methods were used throughout."
Reasoning: The methods for synthesizing results and assessing consistency are described.
[Yes]
P15
Quotes: None relevant
Reasoning: Methods for assessing risk of bias that may affect the cumulative evidence are not specified.
[No]
P16
Quotes: None relevant
Reasoning: No additional analyses are mentioned.
[NA]
P17
Quote: See Figure 1 study flow diagram.
Reasoning: A study flow diagram is provided with numbers of studies screened, assessed for eligibility, included, and excluded with reasons.
[Yes]
P18
Quote: "The included studies comprised a total of 804 infants with simple gastroschisis, 488 of whom underwent OPFC and 316 of whom underwent SR. The largest study was Owen 2010 [2] with 290 eligible patients. The majority of the remaining studies included fewer than 50 participants (Table 2)."
Reasoning: Some study characteristics are presented for each included study, but incompletely.
[No]
P19
Quote: "Methodological quality and risk of bias were assessed using the STROBE checklist and GRADE criteria."
Reasoning: Risk of bias assessments are mentioned but the results are not presented for each study.
[No]
P20
Quotes: None relevant
Reasoning: Simple summary data and effect estimates for each study are not provided for any outcomes.
[No]
P21
Quotes: See Figure 2 forest plots and Table 3 summary outcome measures.
Reasoning: Meta-analysis results including odds ratios, mean differences, and confidence intervals are presented for each outcome.
[Yes]
P22
Quotes: None relevant
Reasoning: No assessments of risk of bias across studies are reported.
[NA]
P23
Quotes: None relevant
Reasoning: No additional analyses are reported.
[NA]
P24
Quote: "Our results would appear to suggest a potential benefit to OPFC over SR. A recently published meta-analysis by Kunz et al [13] agrees with these findings when infants with only simple gastroschisis are included. However, when infants with complex gastroschisis are included in their analysis, they arrive at the conclusion that SR is superior to OPFC. This variation in conclusion highlights one of the key limitations of performing meta-analysis in small specialties. With a lack of standardised populations, interventions or outcome measures, and a scarcity of high quality primary data, inclusion criteria for systematic reviews often have to be more lax than is ideal. This leads to the introduction of significant clinical heterogeneity between the included studies, which may lead to a lack of validity for the conclusions of any meta-analysis."
Reasoning: The main findings are summarized along with their strength and relevance to key groups.
[Yes]
P25
Quote: "Although we have attempted to address this potential lack of validity with strict inclusion and exclusion criteria, our conclusion that OPFC is superior to SR must still be tempered by the low quality of the available primary data, and the limitations of our study."
Reasoning: Limitations at the study, outcome, and review level are discussed.
[Yes]
P26
Quote: "A National Paediatric Surgical Trials Unit could act both as a centre to facilitate co-operation between individual surgical centres, and as a research unit in its own right. By encouraging co-operation between individual centres, study power would be improved, heterogeneity between study populations would be reduced and outcome measures would become more standardised. With buy-in and co-operation from each of the individual surgical centres, a National Paediatric Surgical Trials Unit would have the ability to develop an overarching research programme that would allow generation of sufficient quality data to not only evaluate existing practice, but to take new surgical ideas through from initial evaluation to assessment with national randomised controlled trials, and on to large scale review of established practice, as outlined by the IDEAL recommendations [15]. A similar national approach could be used in other smaller surgical specialties."
Reasoning: The authors provide a general interpretation of the results in the context of other evidence and implications for future research.
[Yes]
P27
Quote: "Marian Knight is funded by a National Institute for Health Research Professorship. This article presents independent research partly funded by the National Institute for Health Research (NIHR)."
Reasoning: Sources of funding for the systematic review are described.
[Yes]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
1
|
0
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
0
|
0
|
1
|
0
|
1
|
1
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
0
|
NA
|
1
|
1
|
0
|
1
|
1
|
0
|
NA
|
1
|
1
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
NA
|
1
|
0
|
1
|
1
|
0
|
NA
|
NA
|
1
|
1
|
1
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
1
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
0
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
1
|
1
|
0
|
0
|
1
|
1
|
1
|
NA
|
NA
|
0
|
LLM response
22 quote(s) from
publication full text (mean similarity 99.3%)
A1. Was an 'a priori' design provided?
Quotes: None relevant
Reasoning: The text does not mention a protocol, ethics approval, or pre-determined research objectives.
[No]
A2. Was there duplicate study selection and data extraction?
Quotes: "Data extraction: Retrieved articles were assessed for eligibility and data on patients, intervention, control, outcomes and methodological quality were abstracted independently by two authors. Discrepancies were resolved by discussion and consensus."
Reasoning: Study selection and data extraction were done independently by two authors.
[Yes]
A3. Was a comprehensive literature search performed?
Quotes: "The search strategy is summarized in Fig. 1. All potential publications from Medline (1950–June 2010), Embase (1980–June 2010), The Cochrane Library (issue 2, 2010) and ongoing trials through http://www.clinicaltrials.gov website were identified."
Reasoning: At least 2 electronic databases plus a supplementary source were searched.
[Yes]
A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion?
Quotes: None relevant
Reasoning: The text does not state that they searched for reports regardless of publication type or whether they excluded studies based on publication status.
[No]
A5. Was a list of studies (included and excluded) provided?
Quotes: None relevant
Reasoning: The text does not provide or reference a list of included and excluded studies.
[No]
A6. Were the characteristics of the included studies provided?
Quotes: "Table 1 Comparative studies reporting laparoscopic inguinal hernia repair in infants and children"
Reasoning: Key characteristics of the included studies were provided in an aggregated table.
[Yes]
A7. Was the scientific quality of the included studies assessed and documented?
Quotes: "The quality of the included comparative studies was assessed independently by two authors. The Cochrane Collaboration criteria for randomized controlled trials was utilized (randomization, allocation concealment, blinding and completeness of follow-up). Cohort studies were assessed using the Newcastle-Ottawa Quality Assessment Scale [18]. The methodological details of the included studies were extracted from the published data."
Reasoning: The methodological quality of included studies was assessed using the Cochrane criteria for RCTs and the Newcastle-Ottawa scale for cohort studies.
[Yes]
A8. Was the scientific quality of the included studies used appropriately in formulating conclusions?
Quotes: "Although our review utilized a very comprehensive search strategy to minimize the effect of publication bias, only two randomized clinical trial was included. Therefore, our review is a summary of the existing evidence with limitation to the conclusions drawn from these data due to the quality of the included studies."
Reasoning: The conclusions acknowledge the limitations due to the quality of the included studies.
[Yes]
A9. Were the methods used to combine the findings of studies appropriate?
Quotes: "Heterogeneity was defined as a significant test of heterogeneity (p < 0.1) and/or differences in the treatment effects across studies."
Reasoning: Heterogeneity was assessed to determine appropriateness of combining studies, though a meta-analysis was not performed.
[NA]
A10. Was the likelihood of publication bias assessed?
Quotes: None relevant
Reasoning: Publication bias was not assessed, likely because there were fewer than 10 included studies.
[NA]
A11. Was the conflict of interest included?
Quotes: None relevant
Reasoning: Sources of support for the systematic review and included studies were not acknowledged.
[No]
P1. Title
Quotes: "Laparoscopic versus open inguinal herniotomy in infants and children: a meta-analysis"
Reasoning: The title identifies the report as a meta-analysis.
[Yes]
P2. Abstract / Structured summary
Quotes: The abstract contains labeled sections for Purpose, Methods, Results, and Conclusions.
Reasoning: The abstract is structured with distinct labeled sections covering the key elements.
[Yes]
P3. Introduction / Rationale
Quotes: "Inguinal hernia repair is one of the most frequently performed pediatric surgical operations [1]. Open repair of an inguinal hernia has been accepted as the method of choice since it was first described more than 50 years ago due to its lower morbidity, good cosmesis, and lower rates of recurrence [2–4]."
Reasoning: The introduction describes the rationale for the review in the context of what is known about inguinal hernia repair in children.
[Yes]
P4. Introduction / Objectives
Quotes: "Purpose To undertake a meta-analysis of comparative data of laparoscopic versus open inguinal herniotomy in infants and children."
Reasoning: The purpose statement specifies the review question in terms of the population, interventions and comparator.
[Yes]
P5. Methods / Protocol and registration
Quotes: None relevant
Reasoning: The text does not mention a review protocol or registration.
[No]
P6. Methods / Eligibility criteria
Quotes: "Inclusion criteria: All comparative studies of the laparoscopic and open approaches for indirect inguinal hernia in children aged less than 19 years were selected. The primary outcome measure was the recurrence rate. Other clinically important outcomes such as rate of contralateral PPV, operative time, postoperative pain and recovery, cosmesis, postoperative testicular atrophy, postoperative hydrocele and stitch granuloma/abscess were also sought."
Reasoning: The eligibility criteria for included studies are specified.
[Yes]
P7. Methods / Information sources
Quotes: "The search strategy is summarized in Fig. 1. All potential publications from Medline (1950–June 2010), Embase (1980–June 2010), The Cochrane Library (issue 2, 2010) and ongoing trials through http://www.clinicaltrials.gov website were identified."
Reasoning: The information sources searched are described.
[Yes]
P8. Methods / Search
Quotes: "The following subject headings (MeSH) and text word terms were utilized: inguinal hernia, laparoscopy, minimal access surgery, infant(s), neonate(s), newborn(s), child, paediatric, pediatric. No language restriction was applied. Additional citations were sought using references in articles retrieved from searches."
Reasoning: The full search strategy is not presented, but the key search terms are provided.
[No]
P9. Methods / Study selection
Quotes: None relevant
Reasoning: The process for selecting studies is not explicitly described.
[No]
P10. Methods / Data collection process
Quotes: "Data extraction: Retrieved articles were assessed for eligibility and data on patients, intervention, control, outcomes and methodological quality were abstracted independently by two authors. Discrepancies were resolved by discussion and consensus."
Reasoning: The method of data extraction is described, involving two independent authors and a process for resolving discrepancies.
[Yes]
P11. Methods / Data items
Quotes: None relevant
Reasoning: The text does not explicitly define all variables for which data were sought.
[No]
P12. Methods / Risk of bias in individual studies
Quotes: "The quality of the included comparative studies was assessed independently by two authors. The Cochrane Collaboration criteria for randomized controlled trials was utilized (randomization, allocation concealment, blinding and completeness of follow-up). Cohort studies were assessed using the Newcastle-Ottawa Quality Assessment Scale [18]."
Reasoning: The methods used to assess risk of bias in individual studies are described.
[Yes]
P13. Methods / Summary measures
Quotes: "For dichotomous outcomes, odds ratio (OR) and its associated confidence interval were calculated. For continuous outcomes, treatment effect was expressed as mean difference and its calculated standard deviation."
Reasoning: The principal summary measures are stated.
[Yes]
P14. Methods / Synthesis of results
Quotes: None relevant
Reasoning: Methods for data synthesis are not described, as a meta-analysis was not performed.
[NA]
P15. Methods / Risk of bias across studies
Quotes: None relevant
Reasoning: Methods for assessing risk of bias across studies are not described, as a meta-analysis was not performed.
[NA]
P16. Methods / Additional analyses
Quotes: "A sensitivity analysis was conducted where studies limited to girls, and/or with a median follow-up less than 6 months, and/or addressing a complicated hernia, and/or limited to infants were excluded and the meta-analysis of the remaining 6 comparative studies had shown a comparable recurrence rate among the groups [OR = 0.87; 95% CI 0.34–2.23; p = 0.76] (Fig. 2b)."
Reasoning: A sensitivity analysis was conducted.
[Yes]
P17. Results / Study selection
Quotes: "Initial electronic search yielded 290 Medline, 216 Embase, 5 Cochrane Library (issue 2, 2010) and 7 ClinicalTrials.gov potentially relevant citations. After screening the abstracts, 48 articles were reviewed in full texts. Thirty-four articles have met the predefined inclusion criteria (Fig. 1). Ten published studies were identified (Niyogi [19]; Tsai [20]; Koivusalo [21]; Endo [22]; Bharathi [23]; Hassan [24]; Koivusalo [25]; Chan [17]; Oue [26]; Antao [27]) in which the laparoscopic and open approaches for repair of pediatric inguinal hernias were directly compared (Table 1) [17, 19–27]."
Reasoning: A flow diagram of the study selection process is not provided, but the numbers of studies screened, assessed for eligibility, and included are reported in the text.
[No]
P18. Results / Study characteristics
Quotes: "Table 1 Comparative studies reporting laparoscopic inguinal hernia repair in infants and children"
Reasoning: The characteristics of each included study are presented in Table 1.
[Yes]
P19. Results / Risk of bias within studies
Quotes: "Two randomized controlled trial (Koivusalo [21] and Chan [17]), one nonrandomized clinical trial (Tsai [20]) and seven observational comparative studies (Niyogi [19]; Endo [22]; Bharathi [23, 28]; Hassan [24]; Koivusalo [25]; Oue [26]; Antao [27]) were assessed."
Reasoning: The results of the risk of bias assessments for individual studies are summarized.
[Yes]
P20. Results / Results of individual studies
Quotes: "Table 1 Comparative studies reporting laparoscopic inguinal hernia repair in infants and children"
Reasoning: Table 1 presents the key results for each individual study, but does not include effect estimates and confidence intervals.
[No]
P21. Results / Synthesis of results
Quotes: None relevant
Reasoning: A meta-analysis was not performed so there are no synthesis results to present.
[NA]
P22. Results / Risk of bias across studies
Quotes: None relevant
Reasoning: An assessment of risk of bias across studies is not reported, as a meta-analysis was not performed.
[NA]
P23. Results / Additional analysis
Quotes: "A sensitivity analysis was conducted where studies limited to girls, and/or with a median follow-up less than 6 months, and/or addressing a complicated hernia, and/or limited to infants were excluded and the meta-analysis of the remaining 6 comparative studies had shown a comparable recurrence rate among the groups [OR = 0.87; 95% CI 0.34–2.23; p = 0.76] (Fig. 2b)."
Reasoning: The results of the sensitivity analysis are reported.
[Yes]
P24. Discussion / Summary of evidence
Quotes: "Our review examined the safety and efficacy of the laparoscopic approach in the management of inguinal hernias in infants and children. Ten comparative studies were reviewed. Although the data is limited, the laparoscopic approach was associated with a trend towards higher recurrence rate."
Reasoning: The main findings are summarized in the discussion.
[Yes]
P25. Discussion / Limitations
Quotes: "Although our review utilized a very comprehensive search strategy to minimize the effect of publication bias, only two randomized clinical trial was included. Therefore, our review is a summary of the existing evidence with limitation to the conclusions drawn from these data due to the quality of the included studies."
Reasoning: Limitations at the review level are discussed.
[Yes]
P26. Discussion / Conclusions
Quotes: "Despite numerous case series spanning over a decade of surgical practice, only two randomized controlled trials were identified, studying 172 infants and children. The conflicting data revealed by the two randomized controlled trials could be explained partially by the possibility of selection bias and by the presence of potential confounding factors including different operative techniques and lack of standardization of other received treatments [17, 21]."
Reasoning: The conclusions provide a general interpretation of the results in the context of the evidence.
[Yes]
P27. Funding
Quotes: None relevant
Reasoning: Sources of funding for the systematic review are not described.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
1
|
0
|
NA
|
NA
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
0
|
0
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
1
|
1
|
0
|
NA
|
NA
|
NA
|
NA
|
1
|
0
|
0
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
NA
|
NA
|
1
|
1
|
0
|
0
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
0
|
0
|
0
|
1
|
0
|
0
|
NA
|
NA
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
0
|
0
|
0
|
0
|
1
|
0
|
0
|
1
|
0
|
0
|
LLM response
15 quote(s) from
publication full text (mean similarity 96.2%)
A1. Was an 'a priori' design provided?
Quotes: None relevant.
Reasoning: No mention of a protocol, ethics approval, or a priori objectives.
[No]
A2. Was there duplicate study selection and data extraction?
Quotes: None relevant.
Reasoning: No mention of duplicate study selection or data extraction.
[No]
A3. Was a comprehensive literature search performed?
Quotes: "An online database search for all English language articles on pediatric small bowel obstruction, intussusception and laparoscopy in PubMed, Medline and Ovid from January 1990 to April 2012 was performed."
Reasoning: At least 3 databases were searched but no supplementary sources mentioned.
[No]
A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion?
Quotes: None relevant.
Reasoning: No mention of including grey literature or unpublished studies.
[No]
A5. Was a list of studies (included and excluded) provided?
Quotes: None relevant.
Reasoning: No list of included or excluded studies provided.
[No]
A6. Were the characteristics of the included studies provided?
Quotes: "Table 1 Summary data of the selected studies included in the systematic review."
Reasoning: A table with key characteristics of included studies was provided.
[Yes]
A7. Was the scientific quality of the included studies assessed and documented?
Quotes: None relevant.
Reasoning: No assessment of study quality or risk of bias was mentioned.
[No]
A8. Was the scientific quality of the included studies used appropriately in formulating conclusions?
Quotes: None relevant.
Reasoning: Study quality was not assessed (A7) so could not be incorporated into conclusions.
[No]
A9. Were the methods used to combine the findings of studies appropriate?
Quotes: "Owing to the absence of any randomized controlled trials and the heterogeneous nature of studies, a formal meta-analysis was not performed."
Reasoning: Appropriately did not perform meta-analysis due to lack of RCTs and study heterogeneity.
[Yes]
A10. Was the likelihood of publication bias assessed?
Quotes: None relevant.
Reasoning: Publication bias was not assessed.
[No]
A11. Was the conflict of interest included?
Quotes: None relevant.
Reasoning: Sources of funding for the systematic review and included studies were not reported.
[No]
P1. Title: Identify the report as a systematic review, meta-analysis, or both.
Quotes: "Laparoscopic treatment of intussusception in children: A systematic review"
Reasoning: The title identifies the article as a systematic review.
[Yes]
P2. Abstract / Structured summary
Quotes: The abstract contains labeled Background, Methods, Results, and Conclusion sections.
Reasoning: The abstract is structured with the key recommended sections.
[Yes]
P3. Introduction / Rationale
Quotes: "The use of laparoscopy in pediatric surgery has increased significantly in the past 20 years [4–6]. In children, recent meta-analyses comparing open to laparoscopic technique for interventions as diverse as appendectomy [7], splenectomy [8], pyloromyotomy [9] and pyeloplasty [10] have unanimously found a significantly reduced length of hospital stay, a better cosmetic result and a comparable or indeed reduced [9] complication rate using laparoscopy."
Reasoning: Provides rationale by discussing the increasing use and potential benefits of laparoscopy in pediatric surgery.
[Yes]
P4. Introduction / Objectives
Quotes: "We thus aimed to provide the data needed to challenge current clinical practice in favor of a method that allows for earlier discharge, reduced postoperative pain and decreased risk for postoperative SBO. To this end, we have performed a systematic review to assess the overall safety, success rate, complication rate and potential advantages in the laparoscopic treatment of pediatric intussusception."
Reasoning: Clearly states the objectives and key outcomes of interest for the review.
[Yes]
P5. Methods / Protocol and registration
Quotes: None relevant.
Reasoning: No mention of a protocol or registration number.
[No]
P6. Methods / Eligibility criteria
Quotes: "Exclusion criteria were non-English language articles, case reports, laparoscopic-assisted enema reduction and mixed pediatric and adult populations (age cutoff 18 years)."
Reasoning: Eligibility criteria related to study design, publication status, and population are provided.
[Yes]
P7. Methods / Information sources
Quotes: "An online database search for all English language articles on pediatric small bowel obstruction, intussusception and laparoscopy in PubMed, Medline and Ovid from January 1990 to April 2012 was performed."
Reasoning: Databases searched and dates of coverage are reported.
[Yes]
P8. Methods / Search
Quotes: "Likewise, the bibliographies of all articles identified by the search and shows the selection algorithm for the studies included."
Reasoning: The full search strategy is not presented for at least one database.
[No]
P9. Methods / Study selection
Quotes: "Fig. 1 Algorithm for the studies selection (based on PRISMA guidelines)."
Reasoning: A flow diagram of the study screening and selection process is provided.
[Yes]
P10. Methods / Data collection process
Quotes: None relevant.
Reasoning: The data extraction process is not described.
[No]
P11. Methods / Data items
Quotes: None relevant.
Reasoning: The variables for which data were sought are not defined.
[No]
P12. Methods / Risk of bias in individual studies
Quotes: None relevant.
Reasoning: No risk of bias assessment was mentioned.
[No]
P13. Methods / Summary measures
Quotes: None relevant.
Reasoning: Summary measures are not explicitly stated.
[No]
P14. Methods / Synthesis of results
Quotes: "Owing to the absence of any randomized controlled trials and the heterogeneous nature of studies, a formal meta-analysis was not performed."
Reasoning: Meta-analysis was not performed due to lack of RCTs and heterogeneity.
[NA]
P15. Methods / Risk of bias across studies
Quotes: None relevant.
Reasoning: Risk of bias across studies was not assessed.
[NA]
P16. Methods / Additional analyses
Quotes: None relevant.
Reasoning: No additional analyses were mentioned.
[NA]
P17. Results / Study selection
Quotes: "Fig. 1 Algorithm for the studies selection (based on PRISMA guidelines)."
Reasoning: A flow diagram with the number of studies at each stage is provided.
[Yes]
P18. Results / Study characteristics
Quotes: "Table 1 Summary data of the selected studies included in the systematic review."
Reasoning: A table of the characteristics of included studies is provided.
[Yes]
P19. Results / Risk of bias within studies
Quotes: None relevant.
Reasoning: Risk of bias of individual studies was not assessed.
[No]
P20. Results / Results of individual studies
Quotes: "Table 1 Summary data of the selected studies included in the systematic review."
Reasoning: Table 1 provides outcome data for each included study but not effect estimates and confidence intervals.
[No]
P21. Results / Synthesis of results
Quotes: "Owing to the absence of any randomized controlled trials and the heterogeneous nature of studies, a formal meta-analysis was not performed."
Reasoning: Meta-analysis was not performed.
[NA]
P22. Results / Risk of bias across studies
Quotes: None relevant.
Reasoning: Risk of bias across studies was not assessed.
[NA]
P23. Results / Additional analysis
Quotes: None relevant.
Reasoning: No additional analyses were reported.
[NA]
P24. Discussion / Summary of evidence
Quotes: "A large number of pediatric and general surgeons consider laparotomy to be the unequivocal gold standard in the surgical treatment of intussusception. Likewise, pediatric laparoscopy has been consistently associated with a significantly reduced length of stay compared to open surgery, regardless of primary pathology [7–10]. Even if the quality of data, about the difference in LOS between laparoscopic and open reduction of intussusception, is still weak, we believe that it is possible to speculate a shorter LOS after laparoscopy in light of the statistical significance obtained in Table 4 (4 vs. 7 days, p < 0.0001) and the previous pediatric laparoscopic literature [7–10]."
Reasoning: Summarizes key findings and their relevance to pediatric surgeons.
[Yes]
P25. Discussion / Limitations
Quotes: "Limitations of the present study includes the lack of prospective randomized controlled trials (RCT) comparing laparoscopic and open reduction of intussusception. In their absence or in the presence of technical difficulties, the threshold to convert to laparotomy should remain low with the aim to be safe and avoid complications."
Reasoning: Discusses limitations at the study level (lack of RCTs) and review level (technical difficulties leading to conversion).
[Yes]
P26. Discussion / Conclusions
Quotes: "In contrast, this systematic review showed laparoscopy to be safe and efficacious in the treatment of pediatric intussusception even responding to radiologic reduction. A laparoscopic success rate of more than 70% and a low rate of intraoperative (0.4%) and postoperative complications (2.9%) advocate for the use of laparoscopy as the primary surgical technique."
Reasoning: Provides an overall interpretation of the results in the context of laparoscopy as a treatment for pediatric intussusception.
[Yes]
P27. Funding
Quotes: None relevant.
Reasoning: Sources of funding for the systematic review are not reported.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
0
|
0
|
1
|
1
|
0
|
0
|
0
|
1
|
0
|
NA
|
NA
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
0
|
NA
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
0
|
1
|
0
|
NA
|
NA
|
NA
|
NA
|
0
|
0
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
NA
|
NA
|
0
|
1
|
NA
|
1
|
NA
|
NA
|
NA
|
1
|
0
|
1
|
1
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
1
|
0
|
0
|
1
|
0
|
0
|
NA
|
NA
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
0
|
0
|
0
|
0
|
1
|
0
|
NA
|
1
|
NA
|
0
|
LLM response
16 quote(s) from
publication full text (mean similarity 99.9%)
A1. Was an 'a priori' design provided?
Quotes: None relevant.
Reasoning: No mention of a protocol, ethics approval, or a priori objectives.
[No]
A2. Was there duplicate study selection and data extraction?
Quotes: "All English language articles describing the management of RTEF in children were reviewed. A synthesis of the relevant data is presented in a descriptive form due to the heterogeneity of the included articles."
Reasoning: No mention of duplicate study selection or data extraction.
[No]
A3. Was a comprehensive literature search performed?
Quotes: "A Medline, Embase, and web of science searches were performed using the keywords recurrent tracheoesophageal fistula. The index of all issues of the European Journal of Pediatric Surgery, Journal of Pediatric Surgery, Pediatric Surgery International, and the International Journal of Pediatric Otorhinolaryngology was searched for relevant articles; the reference list of all relevant articles was also searched."
Reasoning: Searched 3 databases and reference lists, but no supplementary sources.
[No]
A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion?
Quotes: None relevant.
Reasoning: No mention of including grey literature or unpublished studies.
[No]
A5. Was a list of studies (included and excluded) provided?
Quotes: None relevant.
Reasoning: No list of included or excluded studies provided.
[No]
A6. Were the characteristics of the included studies provided?
Quotes: "A total of 165 cases of RTEF are described and there were 44 (26.7%) cases associated with anastomotic leaks while 35 (21.2%) were associated with anastomotic strictures preceding the diagnosis of RTEF."
Reasoning: Some aggregate characteristics of included studies provided, but not in table format.
[Yes]
A7. Was the scientific quality of the included studies assessed and documented?
Quotes: None relevant.
Reasoning: No assessment of study quality or risk of bias.
[No]
A8. Was the scientific quality of the included studies used appropriately in formulating conclusions?
[NA] - No assessment of study quality was performed.
A9. Were the methods used to combine the findings of studies appropriate?
Quotes: "A synthesis of the relevant data is presented in a descriptive form due to the heterogeneity of the included articles."
Reasoning: Appropriately did not combine studies due to heterogeneity.
[Yes]
A10. Was the likelihood of publication bias assessed?
[NA] - No meta-analysis was performed.
A11. Was the conflict of interest included?
Quotes: "None."
Reasoning: Conflicts of interest statement provided for the review, but not for the included studies.
[No]
P1. Title
Quotes: "Management of Recurrent Tracheoesophageal Fistulas: A Systematic Review"
Reasoning: Identifies the article as a systematic review in the title.
[Yes]
P2. Abstract / Structured summary
Quotes: Entire abstract.
Reasoning: Provides a structured abstract with labeled sections covering background, materials and methods, results, and conclusion.
[Yes]
P3. Introduction / Rationale
Quotes: "The spectrum of esophageal atresia (EA) and tracheoesophageal fistula (TEF) include an isolated EA, EA with a proximal and/or distal TEF and the "H" or "N" type fistula. Since the initial description of the open surgical repair1 and subsequent thoracoscopic approaches2,3 the outcomes have been very encouraging. Anastomotic leaks, esophageal strictures, gastroesophageal reflux, and tracheomalacia are complications pediatric surgeons are familiar with. The incidence of a fistula recurrence range from 1.9 to 11% after open and thoracoscopic repairs.2,4–8 The diagnosis of these recurrent tracheoesophageal fistulas (RTEF) can often be elusive to the unsuspecting physician and the ideal approach to their management is still in debate."
Reasoning: Describes the rationale for the review in the context of what is already known about recurrent tracheoesophageal fistulas.
[Yes]
P4. Introduction / Objectives
Quotes: "We aim to comparatively review all published treatment options, and outcomes, for managing RTEF."
Reasoning: Provides an explicit statement of the review objective.
[Yes]
P5. Methods / Protocol and registration
Quotes: None relevant.
Reasoning: No mention of a review protocol or registration.
[No]
P6. Methods / Eligibility criteria
Quotes: "All English language articles published by August 2013, describing the management of RTEF in children were reviewed."
Reasoning: Specifies eligibility criteria of language, publication date, population and condition.
[Yes]
P7. Methods / Information sources
Quotes: "A Medline, Embase, and web of science searches were performed using the keywords recurrent tracheoesophageal fistula. The index of all issues of the European Journal of Pediatric Surgery, Journal of Pediatric Surgery, Pediatric Surgery International, and the International Journal of Pediatric Otorhinolaryngology was searched for relevant articles; the reference list of all relevant articles was also searched."
Reasoning: Describes the databases searched and the journals hand-searched.
[Yes]
P8. Methods / Search
Quotes: "A Medline, Embase, and web of science searches were performed using the keywords recurrent tracheoesophageal fistula."
Reasoning: Provides the search terms used but not the full search strategy.
[No]
P9. Methods / Study selection
Quotes: "All English language articles describing the management of RTEF in children were reviewed."
Reasoning: States the process for selecting studies based on the eligibility criteria.
[Yes]
P10. Methods / Data collection process
Quotes: None relevant.
Reasoning: No description of the data extraction process.
[No]
P11. Methods / Data items
Quotes: None relevant.
Reasoning: Variables for which data were sought are not defined.
[No]
P12. Methods / Risk of bias in individual studies
Quotes: None relevant.
Reasoning: No assessment of risk of bias in individual studies.
[No]
P13. Methods / Summary measures
[NA] - No meta-analysis was performed.
P14. Methods / Synthesis of results
[NA] - No meta-analysis was performed.
P15. Methods / Risk of bias across studies
[NA] - No meta-analysis was performed.
P16. Methods / Additional analyses
[NA] - No meta-analysis was performed.
P17. Results / Study selection
Quotes: "A total of 44 papers between 1955 and 2013 described 165 patients; 57 ET and 108 OS. Of the 57 ET patients, there was an 84% success rate compared with 93.5% of 108 OS patients; the failed ET cases were all successfully treated by OS."
Reasoning: Provides the number of studies and patients included, but no flow diagram or reasons for exclusions.
[No]
P18. Results / Study characteristics
Quotes: See Table 2.
Reasoning: Study characteristics are provided for each included study.
[Yes]
P19. Results / Risk of bias within studies
[NA] - No assessment of risk of bias was performed.
P20. Results / Results of individual studies
Quotes: See Tables 1-4.
Reasoning: Results are provided for individual studies and groups.
[Yes]
P21. Results / Synthesis of results
[NA] - No meta-analysis was performed.
P22. Results / Risk of bias across studies
[NA] - No assessment of risk of bias across studies was performed.
P23. Results / Additional analysis
[NA] - No additional analyses were performed.
P24. Discussion / Summary of evidence
Quotes: "OS for RTEF has a low morbidity and mortality, a higher success rate, and requires fewer treatments than an endoscopic repair. The ideal ET is undecided but it remains a viable alternative provided treatment failures are anticipated and prompt redo treatments initiated to prevent ongoing respiratory morbidity."
Reasoning: Summarizes the main findings and their relevance to key groups.
[Yes]
P25. Discussion / Limitations
Quotes: "The major complications after OS were 17 (16%) leaks and 4 (3.7%) deaths; while for ET 3 (5%) suffered respiratory distress postoperatively and there was 1 (1.7%) death reported in 2005; this occurred 3 days postprocedure and the cause was unspecified."
Reasoning: Discusses some limitations at the study level but not at the review level.
[No]
P26. Discussion / Conclusions
Quotes: "Minimally invasive techniques are widely accepted to be better tolerated by patients and whenever possible such options should be explored, thus supporting the case for ET; however, the outcomes should be comparable. Several authors have used a variety of techniques for ET, summarized above, all hoping to achieve better outcomes. There have been three literature reviews on ET. In Hoelzer 1999 review,12 15 cases were reported, having been treated with diathermy, laser, n-BCA, and fibrin glue, and 1 to 5 treatments were necessary with complete closure in only 10 patients (67%). Meier et al in 200726 reported an overall success rate of 60% of 62 patients culled from the literature (fibrin glue 55% [n = 22], n-BCA 48% [n = 29], laser 80% [n = 5], diathermy 50% [n = 10], n-BCA + sclerosant100% [n = 5]); the mean number of applications ranged from 1 to 5.5. They concluded that ET is safe, effective, has less morbidity than OS and recommended fibrin glue but advised close follow-up. Richter et al28 in their 2008 review, culled 37 patients from the literature and categorized ET into: application of sealant only (n = 14; 78.6% success), de-epithelialization of the fistula tract only (n = 8; 62.5% success), de-epithelialization combined with sealant (n = 15; 93.3%). Overall there was an 81.1% success rate (48.6% after a single attempt) and they concluded that de-epithelialization with diathermy combined with fibrin glue sealant will yield the best results; fibrin glue by nature would work better if the opposing surfaces are closely apposed and not epithelialized.21 The failures seen with ET may be partly because the sealants fibrin glue and n-BCA are biodegradable. Aproninin, an antifibrinolytic, prolongs the stability of fibrin glue in vivo for up to 10 days only96; however, the fibrin clot formed has a loose scaffold that encourages in-growth of fibroblasts. n-BCA, commonly used for skin closure, is not recommended for mucosal application by most manufacturers, as its stability and possible absorption in such environments is not yet fully determined. Willets et al (1998)55 also appreciating the possibility of late refistulation after ET, and the limited follow-up period of the reported cases managed endoscopically, decided to evaluate the long-term outcome of these patients by contacting the respective authors. They concluded that of 22 patients initially reported to have had successful ET, only 12 (55%) remained closed after a median follow-up of 107 months; there was however no morbidity or mortality directly related to these procedures."
Reasoning: Provides a general interpretation of the results in the context of other evidence and implications for future research.
[Yes]
P27. Funding
Quotes: "None."
Reasoning: Sources of funding for the systematic review are reported.
[Yes]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
0
|
0
|
0
|
1
|
1
|
1
|
1
|
0
|
1
|
NA
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
1
|
NA
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
1
|
1
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
NA
|
NA
|
1
|
1
|
1
|
0
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
1
|
0
|
0
|
0
|
1
|
1
|
1
|
1
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
0
|
1
|
0
|
1
|
1
|
1
|
1
|
NA
|
NA
|
0
|
LLM response
24 quote(s) from
publication full text (mean similarity 98.5%)
A1. Was an 'a priori' design provided?
Quotes: None relevant.
Reasoning: The article does not mention a protocol, ethics approval, or pre-determined research objectives.
[No]
A2. Was there duplicate study selection and data extraction?
Quotes: "Data extraction was conducted by 2 reviewers (LB & AB) using a predefined data extraction worksheet."
Reasoning: Two reviewers conducted data extraction, but duplicate study selection is not mentioned.
[No]
A3. Was a comprehensive literature search performed?
Quotes: "A systematic search of electronic databases was performed to identify all relevant studies comparing two or more gastrostomy insertion techniques in children reporting procedural-related complication rates. A reference librarian was consulted to assist with the development of database-specific search strategies. We used exploded Medical Subject Headings (MeSH) and keywords to search for the following themes: pediatrics, open gastrostomy, percutaneous endoscopic gastrostomy, interventional radiologically guided gastrostomy, and laparoscopic gastrostomy (Appendix 1 for detailed search strategy). We applied the search strategy to the following databases: MEDLINE (PubMed, PubMIsd in Process and Ovid), EMBASE, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Scopus and Cochrane Library."
Reasoning: Multiple electronic databases were searched using a comprehensive search strategy developed with a librarian.
[Yes]
A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion?
Quotes: None relevant.
Reasoning: The article does not mention searching for grey literature or unpublished studies.
[No]
A5. Was a list of studies (included and excluded) provided?
Quotes: "Fig. 1. Consort diagram of articles included in review."
Reasoning: A flow diagram is provided showing the number of studies included and excluded at each stage.
[Yes]
A6. Were the characteristics of the included studies provided?
Quotes: "Table 1 Studies that met inclusion criteria, segregated by procedure. Complication rates and MINORS score are displayed."
Reasoning: Key characteristics of the included studies are provided in an aggregated table.
[Yes]
A7. Was the scientific quality of the included studies assessed and documented?
Quotes: "The methodological index for non-randomized studies (MINORS) was utilized to determine the quality of each of the included studies."
Reasoning: The MINORS tool was used to assess the quality of included studies, with scores reported in Table 1.
[Yes]
A8. Was the scientific quality of the included studies used appropriately in formulating conclusions?
Quotes: "Considerable variation existed in reporting practices of enteral feeding tube gastrostomy insertion. Five studies evaluated this outcome, with three studies demonstrating significantly improved feeding parameters when comparing lap to open GT insertion [3,21,33,34,37]."
Reasoning: The variable quality of studies was considered when interpreting results and drawing conclusions.
[Yes]
A9. Were the methods used to combine the findings of studies appropriate?
Quotes: "The studies not described either failed to report a statistical analysis or did not comment on the above patient demographics."
Reasoning: Quantitative synthesis was not performed, likely due to heterogeneity of studies. This is appropriate for this review.
[NA]
A10. Was the likelihood of publication bias assessed?
Quotes: None relevant.
Reasoning: Publication bias was not assessed, which is appropriate since no quantitative synthesis was performed.
[NA]
A11. Was the conflict of interest included?
Quotes: "We would like to thank Robin Featherstone from the McGill Faculty of Medicine Library for her assistance with the literature search and the retrieval of articles."
Reasoning: Sources of support for the review are acknowledged, but not for the individual included studies.
[No]
P1. Title
Quotes: "A systematic review and meta-analysis of gastrostomy insertion techniques in children"
Reasoning: The title identifies the article as a systematic review and meta-analysis.
[Yes]
P2. Abstract / Structured summary
Quotes: The abstract contains labeled sections for Background, Methods, Results, and Conclusions.
Reasoning: A structured abstract is provided with the required sections.
[Yes]
P3. Introduction / Rationale
Quotes: "Gastrostomy tubes are inserted via multiple techniques to provide a route for enteral feeding in the pediatric population. This review compares the rate of major complications and resource utilization associated with the various insertion techniques."
Reasoning: The rationale for the review is described in the context of current knowledge.
[Yes]
P4. Introduction / Objectives
Quotes: "The primary outcome of interest was postoperative complication resulting in death or requiring operative management within one year - our working definition of a major complication."
Reasoning: The primary outcome of interest is clearly stated, but the full PICOS are not provided.
[No]
P5. Methods / Protocol and registration
Quotes: None relevant.
Reasoning: No mention of a review protocol or registration.
[No]
P6. Methods / Eligibility criteria
Quotes: "All studies that compared postoperative outcomes in two or more gastrostomy placement techniques in a pediatric population were included. The primary outcome of interest was postoperative complication resulting in death or requiring operative management within one year - our working definition of a major complication."
Reasoning: Eligibility criteria for population, interventions, comparators, and primary outcome are provided, but not for study designs or other characteristics.
[No]
P7. Methods / Information sources
Quotes: "We applied the search strategy to the following databases: MEDLINE (PubMed, PubMIsd in Process and Ovid), EMBASE, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Scopus and Cochrane Library. The search was restricted temporally from 1993 to 2013, with no linguistic restriction."
Reasoning: Electronic databases searched and dates of coverage are described.
[Yes]
P8. Methods / Search
Quotes: "Appendix 1. Detailed search strategy for each database"
Reasoning: The full search strategy for multiple databases is provided in the appendix.
[Yes]
P9. Methods / Study selection
Quotes: "All titles and abstracts identified in the electronic database were independently screened for relevance and categorized as relevant, possibly relevant or irrelevant, based on our inclusion criteria. Manuscripts of articles categorized as either relevant or possibly relevant were retrieved for further evaluation."
Reasoning: The process for study selection is described.
[Yes]
P10. Methods / Data collection process
Quotes: "Data extraction was conducted by 2 reviewers (LB & AB) using a predefined data extraction worksheet. The following information was extracted from each article: title, authors, number of centers involved,"
Reasoning: Data extraction was performed in duplicate using a predefined form.
[Yes]
P11. Methods / Data items
Quotes: None relevant.
Reasoning: Variables for which data were sought are not explicitly defined.
[No]
P12. Methods / Risk of bias in individual studies
Quotes: "The methodological index for non-randomized studies (MINORS) was utilized to determine the quality of each of the included studies."
Reasoning: The MINORS tool was used to assess risk of bias in individual studies.
[Yes]
P13. Methods / Summary measures
Quotes: None relevant.
Reasoning: Summary measures are not specified, as no quantitative synthesis was performed.
[NA]
P14. Methods / Synthesis of results
Reasoning: No quantitative synthesis was performed.
[NA]
P15. Methods / Risk of bias across studies
Reasoning: Risk of bias across studies was not assessed, as is appropriate since no quantitative synthesis was performed.
[NA]
P16. Methods / Additional analyses
Reasoning: No additional analyses were reported.
[NA]
P17. Results / Study selection
Quotes: "Fig. 1. Consort diagram of articles included in review."
Reasoning: A flow diagram is provided detailing the study selection process with numbers at each stage.
[Yes]
P18. Results / Study characteristics
Quotes: "Table 1 Studies that met inclusion criteria, segregated by procedure. Complication rates and MINORS score are displayed."
Reasoning: Study characteristics are provided in Table 1.
[Yes]
P19. Results / Risk of bias within studies
Quotes: "The methodological index for non-randomized studies (MINORS) was utilized to determine the quality of each of the included studies."
Reasoning: MINORS scores assessing risk of bias are reported for each included study in Table 1.
[Yes]
P20. Results / Results of individual studies
Quotes: "Table 2 Comparison of studies investigating laparoscopic gastrostomy versus percutaneous endoscopic gastrostomy."
Reasoning: Results for individual studies are provided in Table 2, but no effect estimates or confidence intervals are reported.
[No]
P21. Results / Synthesis of results
Reasoning: No quantitative synthesis was performed.
[NA]
P22. Results / Risk of bias across studies
Reasoning: Risk of bias across studies was not assessed.
[NA]
P23. Results / Additional analysis
Reasoning: No additional analyses were reported.
[NA]
P24. Discussion / Summary of evidence
Quotes: "Gastrostomy tube placement remains a highly popular intervention with a number of indications, in both adult and pediatric populations. Since initially introduced in 1986 as an open surgical approach, it has evolved into a procedure performed using multiple different techniques by several different operators, including surgeons, gastroenterestinal endoscopists and interventional radiologists."
Reasoning: The main findings are summarized, considering their relevance to key stakeholders.
[Yes]
P25. Discussion / Limitations
Quotes: "Selection of older, heavier children for the open procedure may be explained by the lack of evidence documenting safety of PEG in infants at the time of study completion. The first large pediatric review reporting safety of PEG in small (<6 kg) neonates with failure to thrive was in 2011 [38]. As there is currently no literature supporting patient age or weight as a predictive factor for success and safety of tube placement, we are unable to draw conclusions on the influence of these discrepancies of baseline demographics on the results. Additionally, the other 7 studies failed to report patient demographic information."
Reasoning: Limitations at the study and review level are discussed.
[Yes]
P26. Discussion / Conclusions
Quotes: "The placement of a gastrostomy tube in a pediatric patient often represents a seminal moment for the child, his/her family and the medical team providing care. The implications of the procedure resonate for years to follow as care plans shift to outpatient management and nutritional needs become definitively addressed. Ultimately, the technique chosen for gastrostomy tube placement should rest with the implicated health care team, individualized for each unique patient circumstance and be based on individual/institutional expertise."
Reasoning: The conclusions provide a general interpretation of the results with implications for practice.
[Yes]
P27. Funding
Quotes: "We would like to thank Robin Featherstone from the McGill Faculty of Medicine Library for her assistance with the literature search and the retrieval of articles."
Reasoning: Sources of support for the review are acknowledged, but funding sources for the individual studies are not reported.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
0
|
0
|
1
|
0
|
0
|
1
|
0
|
0
|
1
|
0
|
0
|
0
|
NA
|
NA
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
1
|
1
|
0
|
0
|
1
|
0
|
0
|
0
|
0
|
1
|
0
|
0
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
0
|
1
|
0
|
NA
|
NA
|
NA
|
NA
|
0
|
0
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
NA
|
NA
|
0
|
1
|
NA
|
0
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
0
|
0
|
0
|
1
|
0
|
0
|
NA
|
NA
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
0
|
0
|
0
|
0
|
1
|
0
|
NA
|
NA
|
NA
|
0
|
LLM response
20 quote(s) from
publication full text (mean similarity 97.1%)
A1 - Was an 'a priori' design provided?
Quote: "The current literature was screened for publications regarding the application of Mitomycin C in esophageal stenosis and stricture with special emphasis on pediatric data."
The authors describe their literature search methods, but do not mention an a priori protocol or pre-specified objectives.
[No]
A2 - Was there duplicate study selection and data extraction?
No quotes identified. The authors do not mention any procedures for duplicate study selection or data extraction.
[No]
A3 - Was a comprehensive literature search performed?
Quote: "The screen included the use of Mitomycin C in other subspecialties such as ophthalmology; ear, nose, and throat surgery; as well as animal models."
The authors searched multiple subspecialties and animal models, indicating a comprehensive search, but do not provide details on databases, years, keywords, or supplementary strategies.
[No]
A4 - Was the status of publication (i.e. grey literature) used as an inclusion criterion?
No quotes identified. The authors do not specify whether they included or excluded studies based on publication type.
[No]
A5 - Was a list of studies (included and excluded) provided?
Quote: "Values in parentheses represent the mean."
The authors report the number of studies analyzed but do not provide a list of the included and excluded studies.
[No]
A6 - Were the characteristics of the included studies provided?
Quote: "Table 2 Overview on Existing Literature—Patient's Age, Etiology, and Morphology of Esophageal Stricture and Stenosis"
The authors provide an aggregated table of key characteristics of the included studies.
[Yes]
A7 - Was the scientific quality of the included studies assessed and documented?
No quotes identified. The authors do not report assessing the quality of individual studies.
[No]
A8 - Was the scientific quality of the included studies used appropriately in formulating conclusions?
Not applicable, as study quality was not assessed (A7).
[NA]
A9 - Were the methods used to combine the findings of studies appropriate?
Not applicable, as this review does not appear to include a quantitative synthesis or meta-analysis.
[NA]
A10 - Was the likelihood of publication bias assessed?
Not applicable, as this review does not include a quantitative synthesis.
[NA]
A11 - Was the conflict of interest included?
Quote: "M. Berger was supported by the German Academic Exchange Service (DAAD, Deutscher Akademischer Austauschdienst)."
The authors report a funding source for the review but do not report funding sources for each included study.
[No]
P1 - Title: Identify the report as a systematic review, meta-analysis, or both.
Quote: "Mitomycin C in the Therapy of Recurrent Esophageal Strictures: Hype or Hope?"
The title does not identify the article as a systematic review or meta-analysis.
[No]
P2 - Abstract: Structured summary
Quote: "Abstract Introduction Esophageal strictures refractory to conservative treatment represent a major problem in children. The application of Mitomycin C to the site of stricture has been introduced, but the experience with this novel approach remains very limited. Methods Systematic review of publications on the topical application of Mitomycin C in children with persistent esophageal stricture. Results We identified 11 publications including 31 cases."
The abstract has distinct labeled sections for Introduction, Methods, and Results.
[Yes]
P3 - Introduction: Rationale
Quote: "For centuries, esophageal strictures have been recognized as an important health problem in children.1–3 The etiology includes surgery for malformations of the foregut such as esophageal atresia (EA) and tracheoesophageal fistula (TEF), the ingestion of caustic agents, severe gastroesophageal reflux, and other disease entities."
The introduction describes the background and rationale for the review.
[Yes]
P4 - Introduction: Objectives
Quote: "The traditional initial treatment of esophageal strictures is intraluminal dilation. Different methods to achieve adequate luminal dimension have been described including Tucker's dilators, Savary-Gillard bougies or Eder-Puestow metal olives,"
The introduction discusses treatment of esophageal strictures but does not provide an explicit statement of the review questions and PICOS elements.
[No]
P5 - Methods: Protocol and registration
No quotes identified. The authors do not mention a review protocol or registration number.
[No]
P6 - Methods: Eligibility criteria
Quote: "The screen included the use of Mitomycin C in other subspecialties such as ophthalmology; ear, nose, and throat surgery; as well as animal models. Data were collected on the patient population treated, indication, description of stricture, technique of application, dosage, number of and interval between applications, complications, and outcome."
The authors specify the study characteristics and report characteristics used as eligibility criteria.
[Yes]
P7 - Methods: Information sources
Quote: "The current literature was screened for publications regarding the application of Mitomycin C in esophageal stenosis and stricture with special emphasis on pediatric data."
The authors describe the information sources searched but do not provide specific databases or dates.
[No]
P8 - Methods: Search
No quotes identified. The authors do not present the full search strategy for any database.
[No]
P9 - Methods: Study selection
Quote: "We identified 11 publications including 31 cases."
The authors report the number of included studies and cases but do not describe the process for selecting studies.
[No]
P10 - Methods: Data collection process
No quotes identified. The authors do not describe the method of data extraction.
[No]
P11 - Methods: Data items
Quote: "Data were collected on the patient population treated, indication, description of stricture, technique of application, dosage, number of and interval between applications, complications, and outcome."
The authors list the data items collected.
[Yes]
P12 - Methods: Risk of bias in individual studies
No quotes identified. The authors do not describe methods for assessing risk of bias in individual studies.
[No]
P13 - Methods: Summary measures
No quotes identified. The authors do not state the principal summary measures.
[No]
P14 - Methods: Synthesis of results
Not applicable, as no meta-analysis was conducted.
[NA]
P15 - Methods: Risk of bias across studies
Not applicable, as no meta-analysis was conducted.
[NA]
P16 - Methods: Additional analyses
Not applicable, as no meta-analysis was conducted.
[NA]
P17 - Results: Study selection
Quote: "We identified 11 publications including 31 cases."
The authors report the total number of included studies and cases but do not provide a flow diagram with reasons for exclusions at each stage.
[No]
P18 - Results: Study characteristics
Quote: "Table 2 Overview on Existing Literature—Patient's Age, Etiology, and Morphology of Esophageal Stricture and Stenosis"
The authors provide a table of characteristics for each included study with citations.
[Yes]
P19 - Results: Risk of bias within studies
Not applicable, as risk of bias was not assessed (P12).
[NA]
P20 - Results: Results of individual studies
Quote: "Table 1 displays the variety of Mitomycin C application. By combining the keyword "Mitomycin C" with "eye" or "airway" more than 1400 PubMed publications were detected."
The authors provide some summary data for individual studies in tables but do not include effect estimates and confidence intervals for all outcomes.
[No]
P21 - Results: Synthesis of results
Not applicable, as no meta-analysis was conducted.
[NA]
P22 - Results: Risk of bias across studies
Not applicable, as no meta-analysis was conducted.
[NA]
P23 - Results: Additional analysis
Not applicable, as no additional analyses were reported.
[NA]
P24 - Discussion: Summary of evidence
Quote: "The early results of topical Mitomycin C application for the treatment of severe, recurrent esophageal strictures refractory to repeated balloon dilations are encouraging. The application of Mitomycin C, at short follow-up, was shown to be safe, and no complications or dysplasia were acknowledged."
The authors summarize the main findings and their relevance.
[Yes]
P25 - Discussion: Limitations
Quote: "Although the etiology causing the stenosis was very heterogeneous, all children were homogenous in that repeated dilations did not show improvement and that none had previously been treated with Mitomycin C."
The authors acknowledge limitations regarding the heterogeneity of etiologies and lack of prior Mitomycin C treatment.
[Yes]
P26 - Discussion: Conclusions
Quote: "Several aspects should be considered when interpreting these results. All cases had severe esophageal strictures refractory to repeated dilations. In this patient population, any minor improvement must be appreciated as a success."
The authors provide a general interpretation and implications for future research.
[Yes]
P27 - Funding
Quote: "M. Berger was supported by the German Academic Exchange Service (DAAD, Deutscher Akademischer Austauschdienst)."
The authors describe a funding source for the review but not for individual studies.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
1
|
0
|
1
|
0
|
0
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
0
|
0
|
0
|
1
|
1
|
1
|
1
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
0
|
NA
|
0
|
1
|
0
|
1
|
1
|
0
|
NA
|
0
|
0
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
0
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
1
|
1
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
1
|
0
|
0
|
1
|
1
|
1
|
1
|
0
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
0
|
1
|
0
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
LLM response
24 quote(s) from
publication full text (mean similarity 99.2%)
A1 - Was an 'a priori' design provided?
Quote: "A computerized comprehensive search supplemented by a manual review of the literature was performed for all peer-reviewed publications comparing laparoscopic and open appendectomy, fundoplication and hernia repair cohorts."
The authors mention performing a comprehensive literature search, but do not specify an a priori protocol or predetermined objectives.
[No]
A2 - Was there duplicate study selection and data extraction?
Quote: "A total of 24 articles were identified that met the search and inclusion criteria."
The authors do not mention any duplicate study selection or data extraction process.
[No]
A3 - Was a comprehensive literature search performed?
Quote: "To complete this study a comprehensive literature review was conducted. All available electronic databases including the British Nursing Index (BNI), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, EMBASE (Excerpta Medica), Intute: Health & Life Sciences, MEDLINE, PubMed, BIOSIS Previews, ISI Web of Knowledge, ISI Web of Science and IngentaConnect, were systematically searched for each procedure, between the period 1992–2009 for all English and non-English language articles."
The authors searched a comprehensive set of databases over a wide date range.
[Yes]
A4 - Was the status of publication (i.e. grey literature) used as an inclusion criterion?
The authors do not mention including or excluding studies based on publication status or grey literature.
[No]
A5 - Was a list of studies (included and excluded) provided?
The authors provide a table (Table 1) listing the 24 included studies, but do not provide a list of excluded studies.
[No]
A6 - Were the characteristics of the included studies provided?
Quote: "The study design and methodological quality of the included studies are summarized in Table 1."
Table 1 provides key characteristics of the included studies like procedure type, sample sizes, study design, and quality score.
[Yes]
A7 - Was the scientific quality of the included studies assessed and documented?
Quote: "The study design and methodological quality of the included studies are summarized in Table 1."
Table 1 includes a "Study Quality" column assessing the quality of each included study on a scale of 1-2.
[Yes]
A8 - Was the scientific quality of the included studies used appropriately in formulating conclusions?
The authors do not appear to consider the quality assessments when discussing the results or formulating conclusions.
[No]
A9 - Were the methods used to combine the findings of studies appropriate?
Quote: "Meta-analysis was conducted using weighted mean differences (WMD) as the summary statistic, comparing the laparoscopic treatment groups with the reference (open surgery) groups using the Mantel-Haenszel method."
The authors used appropriate meta-analytic methods to combine the results.
[Yes]
A10 - Was the likelihood of publication bias assessed?
The authors do not mention assessing publication bias.
[No]
A11 - Was the conflict of interest included?
The authors do not provide any conflict of interest disclosures for the systematic review itself or the included studies.
[No]
P1 - Title: Identify the report as a systematic review, meta-analysis, or both.
Quote: "Pediatric Surgical Technique: Laparoscopic or Open Approach? A systematic Review and Meta-Analysis"
The title identifies the article as both a systematic review and meta-analysis.
[Yes]
P2 - Abstract / Structured summary
The abstract is structured with labeled sections for Introduction, Method/Design, Results, and Conclusion, summarizing the key aspects of the review.
[Yes]
P3 - Introduction / Rationale
Quote: "As in adult surgery, laparoscopy has become an integral part of pediatric surgical practice [6–8,18]. One study in 1998 surveyed pediatric surgeons in the United States and Canada to determine the extent of incorporation of laparo-"
The introduction provides rationale by discussing the increasing use of laparoscopy in pediatric surgery.
[Yes]
P4 - Introduction / Objectives
Quote: "The laparoscopic treatment of pediatric populations remains controversial. In order to evaluate the clinical and cost-effectiveness of this surgical approach a number of outcome measures for"
The introduction states the objectives of evaluating clinical and cost-effectiveness of the laparoscopic approach.
[Yes]
P5 - Methods / Protocol and registration
The authors do not mention a pre-registered protocol.
[No]
P6 - Methods / Eligibility criteria
Quote: "Inclusion criteria: Prospective randomized or prospective non-randomized study format only. Operative results reported for a "pediatric population", using the words "children, infants or neonates" to describe the study group and including infants, neonates or children (or combinations of the three). Study subjects under 17 years of age only. Comparison of laparoscopic and open techniques."
The authors specify the inclusion criteria in terms of study design, population, and intervention.
[Yes]
P7 - Methods / Information sources
Quote: "To complete this study a comprehensive literature review was conducted. All available electronic databases including the British Nursing Index (BNI), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, EMBASE (Excerpta Medica), Intute: Health & Life Sciences, MEDLINE, PubMed, BIOSIS Previews, ISI Web of Knowledge, ISI Web of Science and IngentaConnect, were systematically searched for each procedure, between the period 1992–2009 for all English and non-English language articles."
The authors list the databases searched and date ranges.
[Yes]
P8 - Methods / Search
The authors state the databases searched but do not provide the full search strings to allow replication.
[No]
P9 - Methods / Study selection
Quote: "A total of 24 articles were identified that met the search and inclusion criteria."
The number of included studies is provided but the selection process is not described in detail.
[No]
P10 - Methods / Data collection process
The data extraction process is not described.
[No]
P11 - Methods / Data items
Quote: "laparoscopic and open techniques were analyzed in a comparative fashion. These outcome measures included: Length of stay (LOS) after the procedure, Operating room (OR) time, Frequency of postoperative complications and Total hospital costs."
The authors list the data items collected from studies.
[Yes]
P12 - Methods / Risk of bias in individual studies
Quote: "The study design and methodological quality of the included studies are summarized in Table 1."
The authors assessed study quality on a 1-2 scale as shown in Table 1.
[Yes]
P13 - Methods / Summary measures
Quote: "Meta-analysis was conducted using weighted mean differences (WMD) as the summary statistic"
The weighted mean difference is specified as the effect measure.
[Yes]
P14 - Methods / Synthesis of results
Quote: "Meta-analysis was conducted using weighted mean differences (WMD) as the summary statistic, comparing the laparoscopic treatment groups with the reference (open surgery) groups using the Mantel-Haenszel method."
The meta-analysis methods are described.
[Yes]
P15 - Methods / Risk of bias across studies
Assessment of bias across studies like publication bias is not mentioned.
[No]
P16 - Methods / Additional analyses
The authors do not describe any additional analyses.
[No]
P17 - Results / Study selection
Quote: "A total of 24 articles were identified that met the search and inclusion criteria."
The number of included studies is provided but a full study flow diagram is not included.
[No]
P18 - Results / Study characteristics
Quote: "The study design and methodological quality of the included studies are summarized in Table 1."
Table 1 provides the key characteristics of each included study.
[Yes]
P19 - Results / Risk of bias within studies
Quote: "The study design and methodological quality of the included studies are summarized in Table 1."
The 1-2 quality scores for each study are provided in Table 1.
[Yes]
P20 - Results / Results of individual studies
The results of individual studies are not reported, only the pooled meta-analysis results are provided.
[No]
P21 - Results / Synthesis of results
Quotes: "Fig. 1 Forest plot of length of stay ratio meta-analysis." "Fig. 2 Forest plot of operating room time ratio meta-analysis." "Fig. 3 Forest plot of total cost ratio meta-analysis."
The meta-analysis results are reported with forest plots and confidence intervals.
[Yes]
P22 - Results / Risk of bias across studies
Assessment of bias across studies is not reported.
[No]
P23 - Results / Additional analysis
No additional analyses are reported.
[No]
P24 - Discussion / Summary of evidence
Quote: "LOS and OR times: Fig. 1, 2 present the comprehensive analysis of all 24 studies, with study specific mean differences and overall LOS and OR weighted mean differences. Clearly, LOS is significantly reduced in favor of the laparoscopic approach, with an overall weighted mean difference for LOS of -1.44 days (95% CI, -1.89 to -0.99, p<0.001), although the OR time is significantly increased, with a weighted mean difference of +12.8 min (95% CI, +3.7 to +21.9, p=0.006), favoring the open surgical technique."
The authors summarize the key findings for the main outcomes.
[Yes]
P25 - Discussion / Limitations
Quote: "The validity of the results of this review largely depends on the validity of the included studies. Many of the included studies failed to take all the steps necessary to avoid bias. There may well be an inherent bias in the analyses, which are likely to favor the 'newer' MIS/laparoscopic technique. The study will tend to select series performed by surgeons confident with MIS, whose results may not be suitable for generalizations. Those less confident/happier with conventional techniques may fare better doing 'what they know'. The only way of ensuring confidence in our findings would be by only including combination trials (ideally crossover). Conclusions are, therefore, limited by the quality of the included studies and the information provided."
The authors discuss several important limitations of the review.
[Yes]
P26 - Discussion / Conclusions
Quote: "This review strengthens the use of MIS in pediatric populations, demonstrating that the three laparoscopic procedures reviewed showed better patient outcomes compared to open procedures in the form of reduced LOS and complication rates."
The authors provide an overall conclusion interpreting the results.
[Yes]
P27 - Funding
No funding sources are reported for the systematic review.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
0
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
0
|
0
|
0
|
1
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
1
|
NA
|
1
|
1
|
0
|
1
|
1
|
0
|
NA
|
1
|
1
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
1
|
1
|
1
|
NA
|
1
|
NA
|
NA
|
1
|
1
|
1
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
1
|
1
|
0
|
0
|
1
|
0
|
0
|
1
|
0
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
0
|
1
|
0
|
0
|
1
|
0
|
NA
|
1
|
0
|
0
|
LLM response
20 quote(s) from
publication full text (mean similarity 99.6%)
A1. Was an 'a priori' design provided?
Quotes: None relevant.
Reasoning: No mention of a protocol, ethics approval, or a priori objectives.
[No]
A2. Was there duplicate study selection and data extraction?
Quotes: "Two additional papers were retrieved during full text screening. One potentially relevant paper could not be sourced (24), and one was collected via contacting the author (25)."
Reasoning: Duplicate study selection is mentioned for full text screening, but not for abstract screening or data extraction.
[No]
A3. Was a comprehensive literature search performed?
Quotes: "The indexed reference libraries EMBASE and Medline were searched between January 1955 and January 2013 using the search terms presented in Table 1, using mapped and exploded terms. Additionally, the references of all included studies, the Cochrane Library and the titles of papers published in the journal Obesity Surgery from January 1992 till January 2013 were searched. Only papers written in English were retrieved."
Reasoning: At least 2 databases plus reference checking were searched.
[Yes]
A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion?
Quotes: None relevant.
Reasoning: No mention of including grey literature or unpublished studies.
[No]
A5. Was a list of studies (included and excluded) provided?
Quotes: "A total of 2303 unique citations were returned by the search strategy (Fig. 1). Of these, 2185 were excluded based on abstract review. Two additional papers were retrieved during full text screening. One potentially relevant paper could not be sourced (24), and one was collected via contacting the author (25)."
Reasoning: A flow diagram is provided with reasons for exclusions, but no list of excluded studies.
[No]
A6. Were the characteristics of the included studies provided?
Quotes: "The median number of patients at baseline in each study was 24 (range 10-130). In total, 637 patients were analysed at post-surgery follow-up. All 23 studies included a greater proportion of women than men (range 51-81%). Pre-surgery BMI was similar for surgery types, although was highest in RYGB studies (median pre-surgery BMI in RYBG, AGB and SG: 52.4, 46.1 and 49.6, respectively). Seven RYGB, 11 AGB studies and 3 SG studies were sourced."
Reasoning: Aggregate characteristics of the included studies are provided.
[Yes]
A7. Was the scientific quality of the included studies assessed and documented?
Quotes: None relevant.
Reasoning: No mention of assessing study quality or risk of bias.
[No]
A8. Was the scientific quality of the included studies used appropriately in formulating conclusions?
[NA] - Quality was not assessed (A7).
A9. Were the methods used to combine the findings of studies appropriate?
Quotes: "Formulas outlined in the Cochrane Guidelines were used to derive necessary statistics or process individual data from each of the studies included in the meta-analysis (20). Median BMI estimates were not included in our review as variances are needed to meta-analyse data."
Reasoning: Appropriate methods were used to combine the studies in meta-analysis.
[Yes]
A10. Was the likelihood of publication bias assessed?
Quotes: None relevant.
Reasoning: Publication bias was not assessed.
[No]
A11. Was the conflict of interest included?
Quotes: "No conflict of interest was declared."
Reasoning: Conflicts of interest were reported for the systematic review but not for the individual studies.
[No]
P1. Title
Quotes: "Bariatric surgery for obese children and adolescents: a systematic review and meta-analysis"
Reasoning: The title identifies the article as a systematic review and meta-analysis.
[Yes]
P2. Abstract / Structured summary
Quotes: The abstract contains labeled sections for Summary, Keywords, and Introduction.
Reasoning: The abstract is structured with background, objectives, data sources, study eligibility criteria, participants, study appraisal and synthesis methods, results, limitations, and conclusions.
[Yes]
P3. Introduction / Rationale
Quotes: "The global prevalence of obesity is rising in children and adolescents (1). In the United Kingdom, e.g. among individuals aged 11-15 years, the prevalence was 14.7% in 1995 and 18.3% in the 2010 round of the National Child Measurement Programme (2). The largest increases in body mass index (BMI) are seen in the top 5% of the BMI distribution (3). Treatment guidelines for obese children from National Institute for Health and Clinical Excellence (NICE) recommend lifestyle intervention support, assessment of co-morbidities, and referral to secondary care if morbidities are present (3,4). Children and adolescents for whom lifestyle change and standard clinical care are ineffective in reducing BMI are increasingly being considered for bariatric surgery, which encompasses a number of different surgical procedures (4)."
Reasoning: The introduction describes the rationale for the review in the context of rising childhood obesity prevalence and treatment guidelines.
[Yes]
P4. Introduction / Objectives
Quotes: "We aimed to (i) systematically review the literature on bariatric surgery in children and adolescents; (ii) meta-analyse change in BMI separately by surgery type and (iii) report complications, co-morbidity resolution and health-related quality of life (HRQoL)."
Reasoning: The objectives are explicitly stated with reference to participants, interventions, and outcomes.
[Yes]
P5. Methods / Protocol and registration
Quotes: None relevant.
Reasoning: No mention of a protocol or registration number.
[No]
P6. Methods / Eligibility criteria
Quotes: "Studies were included if (i) they assessed BMI before and a minimum of six months after individuals predominately received AGB, RYGB, BPD or SG and (ii) the mean age of the population was between 6 and 18 years at study entry (18)."
Reasoning: The eligibility criteria for study design, participants, interventions and outcomes are specified.
[Yes]
P7. Methods / Information sources
Quotes: "The indexed reference libraries EMBASE and Medline were searched between January 1955 and January 2013 using the search terms presented in Table 1, using mapped and exploded terms. Additionally, the references of all included studies, the Cochrane Library and the titles of papers published in the journal Obesity Surgery from January 1992 till January 2013 were searched."
Reasoning: The information sources searched are described with dates of coverage.
[Yes]
P8. Methods / Search
Quotes: "Search terms for EMBASE and Medline via Ovid SP 1. child/ or adolescent/ or paediatric/ 2. (child$ or young person$ or adolescent or paediatric).ab,ti. 3. bariatric surgery/ or gastric banding/ or stomach bypass/ or sleeve gastrectomy/ or biliopancreatic bypass/ 4. ('gastric bypass' or 'gastric banding' or 'sleeve gastrectomy' or 'biliopancreatic diversion').ab,ti. 5. (1 or 2) and (3 or 4)"
Reasoning: The full search strategy is provided for EMBASE and Medline.
[Yes]
P9. Methods / Study selection
Quotes: "A total of 2303 unique citations were returned by the search strategy (Fig. 1). Of these, 2185 were excluded based on abstract review. Two additional papers were retrieved during full text screening."
Reasoning: The process of screening and selecting studies is described.
[Yes]
P10. Methods / Data collection process
Quotes: None relevant.
Reasoning: The data collection process is not described in detail.
[No]
P11. Methods / Data items
Quotes: None relevant.
Reasoning: The variables for which data were sought are not explicitly defined.
[No]
P12. Methods / Risk of bias in individual studies
Quotes: None relevant.
Reasoning: The methods for assessing risk of bias are not described.
[No]
P13. Methods / Summary measures
Quotes: "Formulas outlined in the Cochrane Guidelines were used to derive necessary statistics or process individual data from each of the studies included in the meta-analysis (20). Median BMI estimates were not included in our review as variances are needed to meta-analyse data. The summary effect measure of unstandardized change in BMI at the time point closest to 12 months post-surgery was produced using the DerSimonian and Laird random effects method (21). The effect of heterogeneity was quantified using the I2 measure and a test of heterogeneity (22)."
Reasoning: The principal summary measures are described (unstandardized change in BMI).
[Yes]
P14. Methods / Synthesis of results
[NA] - Only one meta-analysis was performed.
P15. Methods / Risk of bias across studies
Quotes: None relevant.
Reasoning: Methods for assessing risk of bias across studies are not specified.
[No]
P16. Methods / Additional analyses
Quotes: "We also conducted a number of sensitivity analyses to examine whether change in BMI was effected by (i) the refinement of surgical techniques as publication date increased; (ii) gender and (iii) greater pre-surgery BMI. Funnel plots and Eggar's test were used to examine publication bias and small study effects."
Reasoning: Additional sensitivity analyses are described.
[Yes]
P17. Results / Study selection
Quotes: See Figure 1 flow diagram.
Reasoning: A flow diagram is provided showing the numbers of studies screened, assessed for eligibility, and included with reasons for exclusions at each stage.
[Yes]
P18. Results / Study characteristics
Quotes: See Table 2 with study characteristics.
Reasoning: For each included study, characteristics including sample size, age, BMI, and follow-up are provided along with citations.
[Yes]
P19. Results / Risk of bias within studies
[NA] - Risk of bias was not assessed.
P20. Results / Results of individual studies
Quotes: See Figure 2 forest plot.
Reasoning: For each study, the change in BMI with 95% confidence interval is presented in the forest plot.
[Yes]
P21. Results / Synthesis of results
[NA] - Only one meta-analysis was performed.
P22. Results / Risk of bias across studies
[NA] - Risk of bias across studies was not assessed.
P23. Results / Additional analysis
Quotes: "Surgical techniques differed among the RYGB group (Supporting Information Supplementary Digital Content 1). Only six studies gave details of the procedures completed beyond surgery type. Similarly, information on how measurements were taken, patient inclusion and exclusion criteria, and follow-up protocols were not consistently reported (Supporting Information Supplementary Digital Content 1)."
Reasoning: The results of the additional sensitivity analyses are reported.
[Yes]
P24. Discussion / Summary of evidence
Quotes: "Bariatric surgery in adolescents results in similar short-term weight outcomes to adults, with RYGB producing the greatest weight loss with the most robust evidence base. There are currently no other evidence-based medical interventions that result in similar magnitudes of weight loss, and this review suggests that bariatric surgery should be a treatment option, especially where there are weight-related complications."
Reasoning: The main findings are summarized including the strength of evidence and relevance to key groups.
[Yes]
P25. Discussion / Limitations
Quotes: "As bariatric surgery seems to be associated with a risk of complications and has the potential to impact on different patterns for a lifetime, a balance must be made between the potential benefits and harms at an individual case level. Surgery access is largely mediated through multidisciplinary teams (e.g. paediatricians, psychologists and dieticians) (42,43), and when applied in this context, bariatric surgery appears to be a viable choice to achieve weight loss in obese adolescents for whom all other interventions have failed. In the absence of higher levels of evidence, results from this systematic review appear to suggest that the potential benefits of surgery for weight loss outweigh the risks."
Reasoning: Limitations related to the evidence base and need for balancing risks and benefits are discussed.
[Yes]
P26. Discussion / Conclusions
Quotes: "As such, it is difficult to satisfy the condition of equipoise in an RCT when comparing an instantly reversible therapy (lifestyle or pharmacological intervention) with a surgical intervention that has a different risk profile and cost, and would be difficult to remedy or reverse."
Reasoning: The conclusions provide a general interpretation in the context of other evidence and implications for future research.
[Yes]
P27. Funding
Quotes: "No conflict of interest was declared."
Reasoning: Sources of funding for the systematic review are not described.
[No]
PRISMA
|
|
P1
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P2
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P3
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P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
1
|
0
|
1
|
0
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
0
|
0
|
1
|
0
|
0
|
0
|
0
|
1
|
0
|
0
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
0
|
NA
|
0
|
0
|
0
|
1
|
0
|
0
|
NA
|
1
|
0
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
NA
|
NA
|
0
|
0
|
0
|
1
|
NA
|
NA
|
NA
|
1
|
0
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
0
|
0
|
0
|
0
|
0
|
0
|
NA
|
NA
|
NA
|
0
|
LLM response
16 quote(s) from
publication full text (mean similarity 99.5%)
A1
Quote: "A literature search was performed, using Medline and Pubmed database, on all articles published during the last 10 years (2000-2009), reporting on varicocele treatments."
Reasoning: The authors specified the databases and years searched, indicating an a priori design.
[Yes]
A2
No relevant quotes found.
Reasoning: The authors did not mention duplicate study selection and data extraction.
[No]
A3
Quote: "Searches were also performed using the following key limits: last 10 years, adolescent, randomized controlled trials, meta-analysis, and multicenter retrospective and prospective studies."
Reasoning: The authors searched Medline and PubMed and used additional key limits, but did not mention supplementing with other sources like reviewing references or consulting experts.
[No]
A4
No relevant quotes found.
Reasoning: The authors did not specify whether they included grey literature.
[No]
A5
No relevant quotes found.
Reasoning: The authors did not provide a list of included and excluded studies.
[No]
A6
Quote: "The results of continuous variables were reported as mean ± SD, and the statistical difference was calculated using the Student's t test."
Reasoning: The authors reported some summary statistics of the included studies, but did not provide the full range of characteristics in aggregate form.
[No]
A7
Quote: "Articles with data regarding recurrence, complications (hydrocele, hematoma, atrophy), and, if available, semen parameters after treatment were analyzed."
Reasoning: The authors analyzed studies based on reported data on specific outcomes, but did not specify an a priori method for assessing study quality.
[No]
A8
No relevant quotes found.
Reasoning: Since the authors did not assess study quality, they could not have used it appropriately in the conclusions.
[NA]
A9
Quotes: "To our knowledge, there is no meta-analysis that compares the various techniques for varicocele treatment in children. The only one found in literature concerns adult patients [9]." "Meta-analysis is a useful statistical tool that can be used to compare and integrate different studies in both a qualitative and quantitative way, considering variations in characteristics that can influence the overall estimate of the outcome of interest."
Reasoning: The authors acknowledge the usefulness of meta-analysis for comparing studies, but one was not performed in this review.
[NA]
A10
No relevant quotes found.
Reasoning: The authors did not assess the likelihood of publication bias.
[NA]
A11
No relevant quotes found.
Reasoning: The authors did not report the sources of support for the included studies or for this systematic review.
[No]
P1
Quote: "Laparoscopic vs open varicocelectomy in children and adolescents: review of the recent literature and meta-analysis"
Reasoning: The title identifies the article as a review and meta-analysis.
[Yes]
P2
Quote: "Purpose: Laparoscopic varicocelectomy has gained popularity in recent years. The aim of this study was to identify clinical evidence about the reliability of this technique in the recent literature. Methods: We performed a Medline search for articles published during the last 10 years, using the key words "varicocele," "treatment," and "adolescent." As limits, we used last 10 years, adolescent, clinical trials, randomized controlled trials, meta-analysis, and multicenter retrospective and prospective studies. The results were investigated in recurrence and hydrocele formation."
Reasoning: The abstract includes structured sections with background, objectives, methods, and results.
[Yes]
P3
Quote: "Varicocele is generally considered the most common correctable cause of male infertility [1,2]. It is indicated as a factor in about one third of infertile males, being associated with testicular atrophy and abnormal seminal factors [3]."
Reasoning: The introduction describes the rationale for the review in the context of what is known about varicocele and male infertility.
[Yes]
P4
No relevant quotes found.
Reasoning: The authors did not explicitly state the PICOS for the review question.
[No]
P5
No relevant quotes found.
Reasoning: The authors did not mention the existence of or access to a review protocol.
[No]
P6
Quote: "(1) studies that were not relevant, in which outcome of interest were not reported or were impossible to calculate from the results; and (2) studies not concerning an adolescent population."
Reasoning: The authors specified the study characteristics used as eligibility criteria.
[Yes]
P7
Quote: "A literature search was performed, using Medline and Pubmed database, on all articles published during the last 10 years (2000-2009), reporting on varicocele treatments."
Reasoning: The authors described the databases searched and years covered, but did not specify the date last searched.
[No]
P8
No relevant quotes found.
Reasoning: The authors did not present the full search strategy for any database.
[No]
P9
Quote: "Eleven studies published between 2000 and 2009 matched the inclusion criteria, comparing varicocele treatments in the adolescent population and reporting the incidence of complications."
Reasoning: The authors stated the number of studies included after applying eligibility criteria, but did not fully describe the study selection process.
[No]
P10
Quote: "The results of continuous variables were reported as mean ± SD, and the statistical difference was calculated using the Student's t test."
Reasoning: The authors mentioned how some data were reported and analyzed, but did not fully describe the data collection process.
[No]
P11
Quote: "Articles with data regarding recurrence, complications (hydrocele, hematoma, atrophy), and, if available, semen parameters after treatment were analyzed."
Reasoning: The authors listed the main variables for which data were sought from the studies.
[Yes]
P12
No relevant quotes found.
Reasoning: The authors did not describe methods for assessing risk of bias in the included studies.
[No]
P13
No relevant quotes found.
Reasoning: The authors did not state the principal summary measures.
[No]
P14
No relevant quotes found.
Reasoning: The authors did not perform a meta-analysis.
[NA]
P15
No relevant quotes found.
Reasoning: The authors did not perform a meta-analysis.
[NA]
P16
No relevant quotes found.
Reasoning: The authors did not perform a meta-analysis.
[NA]
P17
No relevant quotes found.
Reasoning: The authors did not provide a flow diagram or full details on the number of studies screened and excluded at each stage.
[No]
P18
No relevant quotes found.
Reasoning: The authors did not present the characteristics and citations of each included study.
[No]
P19
No relevant quotes found.
Reasoning: The authors did not provide data on the risk of bias of each included study.
[No]
P20
Quotes: See Figures 1-4 which present forest plots with odds ratios and 95% confidence intervals for each included study.
Reasoning: The authors provided effect estimates and confidence intervals for the individual studies in forest plots.
[Yes]
P21
No relevant quotes found.
Reasoning: The authors did not perform a meta-analysis.
[NA]
P22
No relevant quotes found.
Reasoning: The authors did not perform a meta-analysis.
[NA]
P23
No relevant quotes found.
Reasoning: The authors did not perform a meta-analysis.
[NA]
P24
Quote: "Varicocele has an adverse effect on the histologic, endocrine, and biochemical testis function [11]. To date, there is controversy over the management of varicocele in children and adolescents. The variety of treatment options indicates that the ideal technique to manage this pathologic condition is not yet been determined."
Reasoning: The authors summarized the main findings and their relevance to key stakeholders.
[Yes]
P25
No relevant quotes found.
Reasoning: The authors did not discuss the limitations of the review at the study, outcome, and review level.
[No]
P26
Quote: "Varicocele has an adverse effect on the histologic, endocrine, and biochemical testis function [11]. To date, there is controversy over the management of varicocele in children and adolescents. The variety of treatment options indicates that the ideal technique to manage this pathologic condition is not yet been determined."
Reasoning: The authors provided a general interpretation of the results in the context of other evidence and the need for determining the ideal treatment technique.
[Yes]
P27
No relevant quotes found.
Reasoning: The authors did not describe the sources of funding or other support for conducting the systematic review.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
0
|
0
|
0
|
0
|
1
|
1
|
0
|
1
|
0
|
NA
|
NA
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
0
|
0
|
0
|
0
|
0
|
NA
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
0
|
0
|
0
|
NA
|
NA
|
NA
|
NA
|
1
|
0
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
NA
|
NA
|
0
|
0
|
0
|
0
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
0
|
0
|
0
|
0
|
1
|
1
|
NA
|
NA
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
0
|
1
|
0
|
0
|
0
|
0
|
0
|
NA
|
NA
|
0
|
LLM response
14 quote(s) from
publication full text (mean similarity 98.6%)
A1
Quote: "We systematically reviewed the literature published during the last 20 years on the treatment of primary proximal hypospadias associated with severe ventral curvature."
Reasoning: The research question and inclusion criteria are clearly stated.
[Yes]
A2
Quotes: No relevant quotes identified.
Reasoning: The authors do not mention whether study selection and data extraction were performed in duplicate.
[No]
A3
Quotes: "We reviewed studies published between 1990 and December 2009, searching for "hypospadias" in MEDLINE®/PubMed®, EMBASE®, Web of Science® and the Cochrane Library."
Reasoning: At least 2 electronic databases were searched and the search term is provided.
[Yes]
A4
Quotes: No relevant quotes identified.
Reasoning: The authors do not state whether they searched for reports regardless of publication type.
[No]
A5
Quotes: No relevant quotes identified.
Reasoning: A list of included and excluded studies is not provided.
[No]
A6
Quote: "We identified 69 studies for review. These studies were generally of low quality (69.5% surgical series)."
Reasoning: Aggregate data on study characteristics are not provided.
[No]
A7
Quote: "We identified 69 studies for review. These studies were generally of low quality (69.5% surgical series)."
Reasoning: The authors assessed study quality in a limited way.
[No]
A8
Quotes: No relevant quotes identified.
Reasoning: The authors do not appear to have used study quality in formulating conclusions.
[No]
A9
Quotes: Not applicable, as no meta-analysis was performed.
Reasoning: The systematic review did not include a meta-analysis.
[NA]
A10
Quotes: Not applicable, as no meta-analysis was performed.
Reasoning: The systematic review did not include a meta-analysis.
[NA]
A11
Quotes: No relevant quotes identified.
Reasoning: Potential sources of support are not acknowledged for the systematic review or included studies.
[No]
P1
Quote: "Surgical Management of Primary Severe Hypospadias in Children: Systematic 20-Year Review"
Reasoning: The title identifies the article as a systematic review.
[Yes]
P2
Quote: The abstract is structured with labeled sections for Purpose, Materials and Methods, Results, and Conclusions.
Reasoning: A structured abstract is provided.
[Yes]
P3
Quote: "The ideal surgical management of primary severe hypospadias (proximal hypospadias with severe ventral curvature) remains controversial."
Reasoning: The rationale for the review is described in the context of what is known.
[Yes]
P4
Quote: "We systematically reviewed the literature published during the last 20 years on the treatment of primary proximal hypospadias associated with severe ventral curvature."
Reasoning: The research question specifies the population, intervention and study design.
[Yes]
P5
Quotes: No relevant quotes identified.
Reasoning: The existence of a review protocol is not mentioned.
[No]
P6
Quote: "We systematically reviewed the literature published during the last 20 years on the treatment of primary proximal hypospadias associated with severe ventral curvature."
Reasoning: The inclusion criteria for study characteristics and report characteristics are described.
[Yes]
P7
Quote: "We reviewed studies published between 1990 and December 2009, searching for "hypospadias" in MEDLINE®/PubMed®, EMBASE®, Web of Science® and the Cochrane Library."
Reasoning: The information sources and dates of coverage are described.
[Yes]
P8
Quotes: No relevant quotes identified.
Reasoning: The full search strategy is not presented.
[No]
P9
Quote: "Selected publications and congress abstracts were studied."
Reasoning: The study selection process is briefly mentioned but not described in detail.
[No]
P10
Quotes: No relevant quotes identified.
Reasoning: The data collection process is not described.
[No]
P11
Quotes: No relevant quotes identified.
Reasoning: The data items collected are not listed or defined.
[No]
P12
Quotes: No relevant quotes identified.
Reasoning: The methods for assessing risk of bias of individual studies are not described.
[No]
P13
Quotes: Not applicable, as no meta-analysis was performed.
Reasoning: The systematic review did not include a meta-analysis.
[NA]
P14
Quotes: Not applicable, as no meta-analysis was performed.
Reasoning: The systematic review did not include a meta-analysis.
[NA]
P15
Quotes: Not applicable, as no meta-analysis was performed.
Reasoning: The systematic review did not include a meta-analysis.
[NA]
P16
Quotes: Not applicable, as no meta-analysis was performed.
Reasoning: The systematic review did not include a meta-analysis.
[NA]
P17
Quote: "The search yielded 69 pertinent studies."
Reasoning: The number of included studies is provided, but a flow diagram is not included and reasons for exclusions are not given.
[No]
P18
Quotes: No relevant quotes identified.
Reasoning: Characteristics of individual studies are not presented.
[No]
P19
Quotes: No relevant quotes identified.
Reasoning: Results of the risk of bias assessment are not presented.
[No]
P20
Quotes: No relevant quotes identified.
Reasoning: Results for individual studies are not provided.
[No]
P21
Quotes: Not applicable, as no meta-analysis was performed.
Reasoning: The systematic review did not include a meta-analysis.
[NA]
P22
Quotes: Not applicable, as no meta-analysis was performed.
Reasoning: The systematic review did not include a meta-analysis.
[NA]
P23
Quotes: Not applicable, as no meta-analysis was performed.
Reasoning: The systematic review did not include a meta-analysis.
[NA]
P24
Quote: "The present systematic review shows the weak evidence backing current management of primary severe hypospadias. We even lack a clear-cut definition of severe hypospadias and associated curvature."
Reasoning: The main findings are summarized.
[Yes]
P25
Quote: "As we continually try to improve the outcomes for our patients with hypospadias, we need to have a better classification system. As the authors indicate, "Future research should strive to stratify included cases accurately based on meatal position and curvature preoperatively, following skin degloving and following each step required for straightening.""
Reasoning: Limitations at the review level are discussed.
[Yes]
P26
Quote: "Clearly it is our obligation to work together with severe hypospadias pediatric urology community so that better outcomes studies can be performed for our patients, ultimately improving their well-being."
Reasoning: A general interpretation is provided in the context of other evidence and implications for future research are discussed.
[Yes]
P27
Quotes: No relevant quotes identified.
Reasoning: Sources of funding for the systematic review are not described.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
1
|
0
|
1
|
1
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
0
|
1
|
1
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
1
|
NA
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
0
|
1
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
NA
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
0
|
0
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
0
|
1
|
0
|
0
|
1
|
0
|
NA
|
1
|
1
|
0
|
LLM response
22 quote(s) from
publication full text (mean similarity 99.9%)
A1 - Was an 'a priori' design provided?
Quotes: "We performed a systematic review of the literature on preputial reconstruction (PR) during hypospadias repair to determine the cumulative risk of preputial skin complications and the influence of PR on urethroplasty complications, namely, fistula formation and overall reoperation rate of the repair."
Reasoning: The research question and inclusion criteria were established before conducting the review.
[Yes]
A2 - Was there duplicate study selection and data extraction?
Quotes: "A second review was performed of these papers and their reference lists."
Reasoning: A second review was performed, but it is unclear if there were at least two independent data extractors and a consensus procedure.
[No]
A3 - Was a comprehensive literature search performed?
Quotes: "A systematic search of the literature published after 06/1995 was performed in 06/2015 using the keyword "hypospadias." Only studies on the outcome of PR in children, defined as dehiscence of the reconstructed prepuce or secondary phimosis needing circumcision, were selected."
Reasoning: At least two databases (MEDLINE/PubMed, Scopus, and Cochrane library) were searched with the keyword "hypospadias".
[Yes]
A4 - Was the status of publication (i.e. grey literature) used as an inclusion criterion?
Quotes: No relevant quotes found.
Reasoning: The authors did not state that they searched for reports regardless of publication type or whether they excluded any reports based on publication status.
[No]
A5 - Was a list of studies (included and excluded) provided?
Quotes: "One-thousand two-hundred thirty records were retrieved by searching MEDLINE/PubMed, 2461 Web of Sciences, and 1 the Cochrane library. Three doctors reviewed separately the abstracts. Papers relevant to the topic of the review were selected by consensus."
Reasoning: The number of included and excluded studies at each stage was provided, but not an actual list of the studies.
[No]
A6 - Were the characteristics of the included studies provided?
Quotes: Table 1 provides characteristics of the included studies such as author, country of origin, type of study, patients undergoing PR/hypospadias repairs, hypospadias severity, and hypospadias repair.
Reasoning: The characteristics of the included studies were provided in an aggregated form in Table 1.
[Yes]
A7 - Was the scientific quality of the included studies assessed and documented?
Quotes: No relevant quotes found.
Reasoning: The authors did not provide any 'a priori' methods for assessing study quality or report the results of a quality assessment.
[No]
A8 - Was the scientific quality of the included studies used appropriately in formulating conclusions?
[NA] - Quality assessment was not performed (A7), so this item is not applicable.
A9 - Were the methods used to combine the findings of studies appropriate?
Quotes: "A meta-analysis (Figure 2) showed no increased risk of urethral fistula formation in patients where the prepuce was preserved, OR (Mantel–Haenszel, fixed effect, 95% CI), 1.25 (0.80–1.97). This was even more evident after exclusion of retrospective studies, i.e., considering only studies with higher LOE (Figure 2)."
Reasoning: A meta-analysis was performed and heterogeneity was assessed using the I2 statistic. Fixed-effects models were used.
[Yes]
A10 - Was the likelihood of publication bias assessed?
Quotes: "Funnel Plot did not show evidence of significant bias among studies (Figure 3)."
Reasoning: Publication bias was assessed using a funnel plot.
[Yes]
A11 - Was the conflict of interest included?
Quotes: No relevant quotes found.
Reasoning: The authors did not acknowledge sources of support or conflict of interest for the systematic review or the included studies.
[No]
P1 - Title
Quotes: "Does Preputial Reconstruction Increase Complication Rate of Hypospadias Repair? 20-Year Systematic Review and Meta-Analysis"
Reasoning: The title identifies the article as a systematic review and meta-analysis.
[Yes]
P2 - Abstract / Structured summary
Quotes: The abstract includes labeled sections for Introduction, Materials and Methods, Results, and Conclusion.
Reasoning: The abstract is structured with distinct labeled sections covering the main PRISMA elements.
[Yes]
P3 - Introduction / Rationale
Quotes: "Preputial asymmetry is one of the components of hypospadias. The prepuce stands like a hood over the glans penis, open ventrally, and redundant dorsally. Preputial reconstruction (PR) is an option during hypospadias repair, but many surgeons favor circumcision for the concern that PR might increase the complication rate of hypospadias repair (1)."
Reasoning: The rationale for the review is described in the context of what is known about preputial reconstruction in hypospadias repair.
[Yes]
P4 - Introduction / Objectives
Quotes: "We performed a systematic review of the literature on preputial reconstruction (PR) during hypospadias repair to determine the cumulative risk of preputial skin complications and the influence of PR on urethroplasty complications, namely, fistula formation and overall reoperation rate of the repair."
Reasoning: The objectives are explicitly stated with reference to participants, interventions, and outcomes.
[Yes]
P5 - Methods / Protocol and registration
Quotes: No relevant quotes found.
Reasoning: The authors did not indicate if a review protocol exists or provide registration information.
[No]
P6 - Methods / Eligibility criteria
Quotes: "Only studies on the outcome of PR in children, defined as dehiscence of the reconstructed prepuce or secondary phimosis needing circumcision, were selected."
Reasoning: The study characteristics used as criteria for eligibility were specified.
[Yes]
P7 - Methods / Information sources
Quotes: "A systematic search of the literature published after 06/1995 was performed in 06/2015 using the keyword "hypospadias." Only studies on the outcome of PR in children, defined as dehiscence of the reconstructed prepuce or secondary phimosis needing circumcision, were selected."
Reasoning: The information sources (literature published after 06/1995) and the date last searched (06/2015) were described.
[Yes]
P8 - Methods / Search
Quotes: No relevant quotes found.
Reasoning: The full electronic search strategy was not presented such that it could be repeated.
[No]
P9 - Methods / Study selection
Quotes: "One-thousand two-hundred thirty records were retrieved by searching MEDLINE/PubMed, 2461 Web of Sciences, and 1 the Cochrane library. Three doctors reviewed separately the abstracts. Papers relevant to the topic of the review were selected by consensus."
Reasoning: The process for selecting studies, including screening and eligibility, was stated.
[Yes]
P10 - Methods / Data collection process
Quotes: No relevant quotes found.
Reasoning: The method of data extraction was not described.
[No]
P11 - Methods / Data items
Quotes: No relevant quotes found.
Reasoning: The authors did not provide a list of variables for which data were sought.
[No]
P12 - Methods / Risk of bias in individual studies
Quotes: No relevant quotes found.
Reasoning: The methods for assessing risk of bias in individual studies were not described.
[No]
P13 - Methods / Summary measures
Quotes: "A meta-analysis (Figure 2) showed no increased risk of urethral fistula formation in patients where the prepuce was preserved, OR (Mantel–Haenszel, fixed effect, 95% CI), 1.25 (0.80–1.97)."
Reasoning: Odds ratio was used as the summary measure in the meta-analysis.
[Yes]
P14 - Methods / Synthesis of results
Quotes: "A meta-analysis (Figure 2) showed no increased risk of urethral fistula formation in patients where the prepuce was preserved, OR (Mantel–Haenszel, fixed effect, 95% CI), 1.25 (0.80–1.97). This was even more evident after exclusion of retrospective studies, i.e., considering only studies with higher LOE (Figure 2)."
Reasoning: The methods for the meta-analysis were described, including the use of fixed-effect models and measures of consistency (I2).
[Yes]
P15 - Methods / Risk of bias across studies
Quotes: "Funnel Plot did not show evidence of significant bias among studies (Figure 3)."
Reasoning: Assessment of risk of bias across studies (publication bias) using a funnel plot was specified.
[Yes]
P16 - Methods / Additional analyses
Quotes: "A meta-analysis (Figure 2) showed no increased risk of urethral fistula formation in patients where the prepuce was preserved, OR (Mantel–Haenszel, fixed effect, 95% CI), 1.25 (0.80–1.97). This was even more evident after exclusion of retrospective studies, i.e., considering only studies with higher LOE (Figure 2)."
Reasoning: Additional analysis excluding retrospective studies was described.
[Yes]
P17 - Results / Study selection
Quotes: Figure 1 provides a flowchart showing the process for selection of studies, with the number of studies at each stage.
Reasoning: The number of studies screened, assessed for eligibility, and included in the review were provided with a flow diagram.
[Yes]
P18 - Results / Study characteristics
Quotes: Table 1 presents the characteristics of each included study.
Reasoning: The characteristics of the included studies were presented with citations.
[Yes]
P19 - Results / Risk of bias within studies
[NA] - Risk of bias assessment was not performed (P12).
P20 - Results / Results of individual studies
Quotes: Table 2 presents the complication rates and reoperation rates for each included study.
Reasoning: For each study, summary data for the intervention groups were provided.
[Yes]
P21 - Results / Synthesis of results
Quotes: "A meta-analysis (Figure 2) showed no increased risk of urethral fistula formation in patients where the prepuce was preserved, OR (Mantel–Haenszel, fixed effect, 95% CI), 1.25 (0.80–1.97). This was even more evident after exclusion of retrospective studies, i.e., considering only studies with higher LOE (Figure 2)."
Reasoning: The results of the meta-analysis were presented, including confidence intervals and measures of consistency.
[Yes]
P22 - Results / Risk of bias across studies
Quotes: "Funnel Plot did not show evidence of significant bias among studies (Figure 3)."
Reasoning: The results of the assessment of risk of bias across studies (publication bias) using a funnel plot were presented.
[Yes]
P23 - Results / Additional analysis
Quotes: "This was even more evident after exclusion of retrospective studies, i.e., considering only studies with higher LOE (Figure 2)."
Reasoning: The results of the additional analysis excluding retrospective studies were provided.
[Yes]
P24 - Discussion / Summary of evidence
Quotes: "This systematic review shows that according to available evidence PR carries an 8% risk of specific preputial complications, whereas it does not seem to increase the risk of urethroplasty complications and the overall reoperation rate of hypospadias repairs."
Reasoning: The main findings were summarized, including the strength of evidence for the main outcomes.
[Yes]
P25 - Discussion / Limitations
Quotes: "Regarding the role of steroid ointment application compared to spontaneous improvement and simple manipulation. Unfortunately, the vast majority of available studies has limited follow-up (below 2 years) to determine the final outcome of PR and none reported results in post-pubertal patients."
Reasoning: Some limitations at the study and review level were discussed.
[Yes]
P26 - Discussion / Conclusions
Quotes: "Preputial reconstruction is an option particularly in patients with distal hypospadias without associated penile curvature. It carries an 8% risk of specific complications, the most common being dehiscence of reconstructed prepuce, whereas secondary phimosis needing circumcision seems to be exceptional although we lack long-term follow-up data on these patients."
Reasoning: A general interpretation of the results in the context of other evidence was provided.
[Yes]
P27 - Funding
Quotes: No relevant quotes found.
Reasoning: The sources of funding for the systematic review were not described.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
NA
|
NA
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
NA
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
1
|
1
|
0
|
NA
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
NA
|
1
|
1
|
0
|
1
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
1
|
1
|
0
|
0
|
1
|
1
|
1
|
NA
|
NA
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
1
|
1
|
0
|
0
|
0
|
1
|
1
|
NA
|
NA
|
0
|
LLM response
17 quote(s) from
publication full text (mean similarity 97%)
A1. Was an 'a priori' design provided?
Quotes: None relevant.
Reasoning: The authors do not mention a protocol, ethics approval, or pre-determined objectives.
[No]
A2. Was there duplicate study selection and data extraction?
Quotes: "Two researchers independently performed each level of screening, comparing the scores for each item on each tool to reach a consensus. If no consensus could be reached, they consulted a third researcher."
Reasoning: Two researchers independently screened studies and compared results to reach consensus.
[Yes]
A3. Was a comprehensive literature search performed?
Quotes: "We conducted electronic searches of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1966 onwards), Embase (1980 onwards), and CINAHL (1982 onwards) to find relevant articles. We used the following search terms: "Cryptorchidism" AND "Orchidopexy" AND "timing" OR "age"."
Reasoning: At least 2 electronic databases were searched along with relevant search terms.
[Yes]
A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion?
Quotes: None relevant.
Reasoning: The authors do not mention searching for grey literature or including unpublished studies.
[No]
A5. Was a list of studies (included and excluded) provided?
Quotes: None relevant.
Reasoning: The authors do not provide a list of included and excluded studies.
[No]
A6. Were the characteristics of the included studies provided?
Quotes: "From there, we were able to reach a conclusion regarding the ideal timing of orchiopexy in cryptorchid children, based on the highest quality research available."
Reasoning: The authors mention reaching a conclusion based on the highest quality research but do not provide the characteristics of the included studies in an aggregated form.
[No]
A7. Was the scientific quality of the included studies assessed and documented?
Quotes: "We used the AMSTAR [20] tool to assess the quality of all relevant systematic reviews. This tool contains 11 items, for a maximum score of 11. Higher scores are indicative of greater methodological quality. This version of the AMSTAR tool includes additional notes to help clarify the items, which were established through conversations with the tool's creator by the Cochrane Effective Practice and Organization of Care review group."
Reasoning: The authors used the AMSTAR tool to assess the methodological quality of the included systematic reviews.
[Yes]
A8. Was the scientific quality of the included studies used appropriately in formulating conclusions?
Quotes: "From there, we were able to reach a conclusion regarding the ideal timing of orchiopexy in cryptorchid children, based on the highest quality research available."
Reasoning: The authors state they based their conclusions on the highest quality evidence available.
[Yes]
A9. Were the methods used to combine the findings of studies appropriate?
Quotes: None relevant.
Reasoning: The authors did not perform a meta-analysis or quantitatively combine study findings.
[NA]
A10. Was the likelihood of publication bias assessed?
Quotes: None relevant.
Reasoning: The authors did not assess publication bias.
[NA]
A11. Was the conflict of interest included?
Quotes: None relevant.
Reasoning: The authors do not report the sources of funding or conflicts of interest for the included studies.
[No]
P1. Title: Identify the report as a systematic review, meta-analysis, or both.
Quote: "Ideal timing of orchiopexy: a systematic review"
Reasoning: The title identifies the article as a systematic review.
[Yes]
P2. Abstract / Structured summary
Quotes: The abstract contains labeled sections for Background, Methods, Results, and Conclusion.
Reasoning: The abstract is structured with distinct labeled sections covering the main PRISMA elements.
[Yes]
P3. Introduction / Rationale
Quote: "Cryptorchidism, the failure of one or both testes to descend into the scrotum prenatally, occurs in 2.4–5 % of newborns [1, 2]. Many of these testes will descend spontaneously shortly after birth, but approximately 23 % will remain undescended unless surgery is performed [3]."
Reasoning: The introduction describes the rationale for the review in the context of what is known about cryptorchidism.
[Yes]
P4. Introduction / Objectives
Quote: "To address this problem, we conducted a systematic review, focusing on fertility and testicular malignancy outcomes, and assessing the quality of each study."
Reasoning: The objectives are stated, mentioning the focus on fertility and malignancy outcomes and quality assessment.
[Yes]
P5. Methods / Protocol and registration
Quotes: None relevant.
Reasoning: The authors do not mention a protocol or registration number.
[No]
P6. Methods / Eligibility criteria
Quote: "We identified all studies that examined the effect of age at orchiopexy on fertility or malignancy, even if these outcomes were not the primary focus. If we deemed a study relevant based on the title and abstract, we obtained the full text article to further screen for relevance."
Reasoning: The eligibility criteria for studies are described.
[Yes]
P7. Methods / Information sources
Quote: "We conducted electronic searches of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1966 onwards), Embase (1980 onwards), and CINAHL (1982 onwards) to find relevant articles."
Reasoning: The electronic databases searched are listed.
[Yes]
P8. Methods / Search
Quote: "We used the following search terms: "Cryptorchidism" AND "Orchidopexy" AND "timing" OR "age"."
Reasoning: The search terms are provided but the full search strategy for at least one database is not presented.
[No]
P9. Methods / Study selection
Quote: "Two researchers independently performed each level of screening, comparing the scores for each item on each tool to reach a consensus. If no consensus could be reached, they consulted a third researcher."
Reasoning: The process for study selection is described.
[Yes]
P10. Methods / Data collection process
Quote: "One researcher extracted data from each of the included studies, and a second researcher checked the data for accuracy and completeness."
Reasoning: The data extraction process is described.
[Yes]
P11. Methods / Data items
Quotes: None relevant.
Reasoning: The authors do not specify all the data items sought.
[No]
P12. Methods / Risk of bias in individual studies
Quotes: "We used the Jadad et al. [21] tool to assess the quality of all relevant RCTs. This scale contains seven items, two of which are reverse-scored. The maximum score is 5, with higher scores indicating greater methodological quality."
"We used the MINORS criteria [22] to assess the quality of all relevant non-randomized studies. This tool contains 12 items, each of which can be scored from 0 to 2, for a maximum possible score of 24 (comparison studies) or 16 (non-comparison studies). Higher scores are indicative of greater methodological quality."
Reasoning: The authors describe using the Jadad and MINORS tools to assess risk of bias in RCTs and non-randomized studies respectively.
[Yes]
P13. Methods / Summary measures
Quotes: None relevant.
Reasoning: The authors do not state the principal summary measures as no quantitative synthesis was performed.
[NA]
P14. Methods / Synthesis of results
Quotes: None relevant.
Reasoning: No quantitative synthesis was performed.
[NA]
P15. Methods / Risk of bias across studies
Quotes: None relevant.
Reasoning: The authors did not assess risk of bias that may affect the cumulative evidence.
[No]
P16. Methods / Additional analyses
Quotes: None relevant.
Reasoning: No additional analyses were reported.
[NA]
P17. Results / Study selection
Quote: See Figure 1 flow diagram.
Reasoning: A flow diagram is provided showing the number of studies at each stage of the selection process.
[Yes]
P18. Results / Study characteristics
Quotes: See Tables 1 and 2 with study characteristics.
Reasoning: The key characteristics of the included studies are provided in table format.
[Yes]
P19. Results / Risk of bias within studies
Quotes: None relevant.
Reasoning: The authors do not present the risk of bias assessments for each included study.
[No]
P20. Results / Results of individual studies
Quotes: See Tables 1 and 2 with study results.
Reasoning: For each study, summary data and effect estimates are provided in the tables.
[Yes]
P21. Results / Synthesis of results
Quotes: None relevant.
Reasoning: No meta-analysis was performed.
[NA]
P22. Results / Risk of bias across studies
Quotes: None relevant.
Reasoning: Risk of bias across studies was not assessed.
[NA]
P23. Results / Additional analysis
Quotes: None relevant.
Reasoning: No additional analyses were reported.
[NA]
P24. Discussion / Summary of evidence
Quote: "The ideal timing of orchiopexy for cryptorchidism has long been debated. Although the recommended age for this surgery has decreased over the years, the literature is still unclear about the exact age at which orchiopexy should be performed to optimize patient outcomes."
Reasoning: The authors summarize the main findings regarding the ideal timing of orchiopexy.
[Yes]
P25. Discussion / Limitations
Quote: "As with all non-RCTs, there are many potential sources of bias. For example, non-RCTs often have ambiguous exclusion criteria for the participants, and the study design does not often involve blinding. In addition, there is risk of selection bias, where the study groups are not equivalent on variables other than the outcome in question."
Reasoning: Limitations of the non-randomized studies are discussed.
[Yes]
P26. Discussion / Conclusions
Quote: "Thus, we recommend that orchiopexy be performed after 6 months of age, to allow for possible natural descent. If the testis remains cryptorchid after 6 months, orchiopexy should be performed as soon as possible—and certainly before 1 year of age—to optimize fertility outcomes."
Reasoning: The authors provide conclusions based on their review.
[Yes]
P27. Funding
Quotes: None relevant.
Reasoning: Sources of funding for the systematic review are not reported.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
1
|
0
|
1
|
1
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
1
|
0
|
1
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
1
|
NA
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
1
|
1
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
NA
|
1
|
1
|
1
|
0
|
1
|
1
|
NA
|
1
|
1
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
1
|
0
|
0
|
1
|
1
|
1
|
1
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
1
|
1
|
0
|
1
|
1
|
1
|
0
|
1
|
1
|
0
|
LLM response
24 quote(s) from
publication full text (mean similarity 98.6%)
A1. Was an 'a priori' design provided?
Quote: "Our objective was to compare the outcomes of these procedures in a systematic review and meta-analysis."
Reasoning: The objective was stated, but no mention of a protocol or pre-registered design.
[No]
A2. Was there duplicate study selection and data extraction?
Quote: "Two researchers independently assessed each study and compared their scores for each item to reach a consensus. If an agreement could not be reached, they consulted a third researcher."
Reasoning: Study selection and quality assessment was done in duplicate.
[Yes]
A3. Was a comprehensive literature search performed?
Quotes: "To identify all studies comparing MIS with open surgery for CDH repair, we conducted an electronic search of MEDLINE (1966 onwards), Embase (1980 onwards), and the Cochrane Central Register of Controlled Trials (CENTRAL)." "All searches were supplemented by searching, thus we included 10 studies in total [8–17]."
Reasoning: At least 2 databases plus reference searching was performed.
[Yes]
A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion?
Reasoning: No mention of including grey literature or unpublished studies.
[No]
A5. Was a list of studies (included and excluded) provided?
Quote: "Our initial search of MEDLINE, Embase and CENTRAL yielded 160 studies (Fig. 1). After applying our exclusion criteria, 9 studies remained. We identified one additional relevant study through hand-searching, thus we included 10 studies in total [8–17]."
Reasoning: A flow diagram of included and excluded studies was provided.
[Yes]
A6. Were the characteristics of the included studies provided?
Quote: "We did not identify any randomized controlled trials (RCTs) as all identified studies were retrospective in nature. Characteristics of studies included in the meta-analysis are detailed in Table 1."
Reasoning: Study characteristics were provided in an aggregated table.
[Yes]
A7. Was the scientific quality of the included studies assessed and documented?
Quote: "Two researchers independently assessed each study for methodological quality using MINORS. The score for each study is reported in Table 1."
Reasoning: Study quality was assessed using the MINORS tool and scores reported for each study.
[Yes]
A8. Was the scientific quality of the included studies used appropriately in formulating conclusions?
Reasoning: The quality of studies was not explicitly considered when formulating conclusions.
[No]
A9. Were the methods used to combine the findings of studies appropriate?
Quotes: "We conducted our meta-analyses using Review Manager 5.2 [6]. For each outcome, we first assessed the heterogeneity of the studies (Chi2 test and I2 statistic). When heterogeneity was low to moderate (Q test p > 0.10, I2 < 50%), we used a fixed-effects model. When heterogeneity was moderate to high (Q test p < 0.10, I2 > 50%), we used a random-effects model [7]."
Reasoning: Appropriate methods were used to assess heterogeneity and combine studies based on heterogeneity.
[Yes]
A10. Was the likelihood of publication bias assessed?
Quote: "To address the risk of publication bias, we created a funnel plot for the recurrence outcome (Fig. 2). All of the studies fell within the 95% confidence interval lines, although the plot was slightly asymmetrical, indicating the possibility of publication bias."
Reasoning: Publication bias was assessed using a funnel plot.
[Yes]
A11. Was the conflict of interest included?
Reasoning: The source of funding for the systematic review was not stated, and conflicts of interest for the included studies were not reported.
[No]
P1. Title
Quote: "Minimally invasive versus open repair of Bochdalek hernia: a meta-analysis"
Reasoning: The title identifies the article as a meta-analysis.
[Yes]
P2. Abstract / Structured summary
Reasoning: The abstract has labeled sections covering background, methods, results, and conclusions.
[Yes]
P3. Introduction / Rationale
Quote: "Traditionally, CDH repair was performed using an open approach, most often by laparotomy. In 1995, Silen performed the first MIS repair on an adolescent patient, and since then the minimally invasive technique has undergone significant evolution [3], becoming increasingly employed over the last 10 years."
Reasoning: The rationale for the review is provided in the context of what is known.
[Yes]
P4. Introduction / Objectives
Quote: "Our objective was to compare the outcomes of these procedures in a systematic review and meta-analysis."
Reasoning: The objective is explicitly stated, although PICOS elements are not fully specified.
[Yes]
P5. Methods / Protocol and registration
Reasoning: No mention of a protocol or registration number.
[No]
P6. Methods / Eligibility criteria
Quote: "Characteristics of studies included in the meta-analysis are detailed in Table 1."
Reasoning: Study characteristics used as eligibility criteria are reported.
[Yes]
P7. Methods / Information sources
Quote: "To identify all studies comparing MIS with open surgery for CDH repair, we conducted an electronic search of MEDLINE (1966 onwards), Embase (1980 onwards), and the Cochrane Central Register of Controlled Trials (CENTRAL). We used the keywords "diaphragmatic hernia", "thoracoscopy", "laparoscopy", "minimally invasive surgery", and "open". We excluded any studies that did not pertain to humans and children."
Reasoning: Electronic databases searched are described with dates of coverage.
[Yes]
P8. Methods / Search
Quote: "We used the keywords "diaphragmatic hernia", "thoracoscopy", "laparoscopy", "minimally invasive surgery", and "open"."
Reasoning: Search terms are provided but the full search strategy for each database is not presented.
[No]
P9. Methods / Study selection
Quote: "Our initial search of MEDLINE, Embase and CENTRAL yielded 160 studies (Fig. 1). After applying our exclusion criteria, 9 studies remained. We identified one additional relevant study through hand-searching, thus we included 10 studies in total [8–17]."
Reasoning: The study selection process is described and shown in a flow diagram.
[Yes]
P10. Methods / Data collection process
Reasoning: The data extraction process is not described.
[No]
P11. Methods / Data items
Reasoning: Variables for which data were sought are not defined.
[No]
P12. Methods / Risk of bias in individual studies
Quote: "Two researchers independently assessed each study for methodological quality using MINORS. The score for each study is reported in Table 1. All studies were retrospective in nature and none employed a blinding technique for data collection."
Reasoning: The MINORS tool was used to assess risk of bias in individual studies.
[Yes]
P13. Methods / Summary measures
Reasoning: The principal summary measures are not stated.
[No]
P14. Methods / Synthesis of results
Quote: "We conducted our meta-analyses using Review Manager 5.2 [6]. For each outcome, we first assessed the heterogeneity of the studies (Chi2 test and I2 statistic). When heterogeneity was low to moderate (Q test p > 0.10, I2 < 50%), we used a fixed-effects model. When heterogeneity was moderate to high (Q test p < 0.10, I2 > 50%), we used a random-effects model [7]."
Reasoning: Methods for data synthesis and assessing consistency are described.
[Yes]
P15. Methods / Risk of bias across studies
Quote: "To address the risk of publication bias, we created a funnel plot for the recurrence outcome (Fig. 2). All of the studies fell within the 95% confidence interval lines, although the plot was slightly asymmetrical, indicating the possibility of publication bias."
Reasoning: Publication bias was assessed using a funnel plot.
[Yes]
P16. Methods / Additional analyses
Reasoning: No additional analyses were mentioned.
[NA]
P17. Results / Study selection
Quote: "Our initial search of MEDLINE, Embase and CENTRAL yielded 160 studies (Fig. 1). After applying our exclusion criteria, 9 studies remained. We identified one additional relevant study through hand-searching, thus we included 10 studies in total [8–17]."
Reasoning: The number of studies screened, assessed for eligibility, and included are reported with reasons for exclusions in a flow diagram.
[Yes]
P18. Results / Study characteristics
Quote: "Characteristics of studies included in the meta-analysis are detailed in Table 1."
Reasoning: Study characteristics are presented for each included study.
[Yes]
P19. Results / Risk of bias within studies
Quote: "Two researchers independently assessed each study for methodological quality using MINORS. The score for each study is reported in Table 1."
Reasoning: Results of the risk of bias assessment for each study are reported.
[Yes]
P20. Results / Results of individual studies
Reasoning: Simple summary data for each group and effect estimates for each study are not provided for all outcomes.
[No]
P21. Results / Synthesis of results
Reasoning: Meta-analysis results with confidence intervals and consistency measures are presented in the forest plots.
[Yes]
P22. Results / Risk of bias across studies
Reasoning: The funnel plot presents the results of the publication bias assessment across studies.
[Yes]
P23. Results / Additional analysis
Reasoning: No additional analyses were reported.
[NA]
P24. Discussion / Summary of evidence
Quote: "This is the largest systematic review and meta-analysis comparing the outcomes of MIS and open surgery for the Bochdalek-type CDH. In 2010, Lansdale et al. [3] conducted a similar meta-analysis, although their review only included 3 studies and examined a limited number of outcomes. Furthermore, they did not perform a separate analysis for patients requiring patch repair. We have conducted a more comprehensive review, in which we include the 3 studies originally reviewed by Lansdale et al., as well as 7 additional studies that have been published in the last 2 years."
Reasoning: The main findings are summarized, including the strength of evidence and relevance to key groups.
[Yes]
P25. Discussion / Limitations
Quote: "Despite the growing popularity of minimally invasive techniques in pediatric surgery, research comparing MIS versus open repair of CDH is scarce. All existing literature is retrospective in design and is thus limited by weaknesses such as selection bias. RCTs are regarded as the highest quality clinical evidence; however it would be difficult, if not impossible, to conduct such studies in this patient group."
Reasoning: Limitations at the study and review level are discussed.
[Yes]
P26. Discussion / Conclusions
Quote: "Our review was significantly longer for MIS than for open surgery. This is consistent with the findings from Lansdale et al. [3], and is likely indicative of the learning curve associated with MIS. It should be noted that there was low to moderate heterogeneity among these studies (I2 = 37%). This may be owing to inconsistency in defining this variable among the different studies."
Reasoning: The conclusions provide an interpretation of the results in the context of other evidence and implications for future research.
[Yes]
P27. Funding
Reasoning: Sources of funding for the systematic review are not described.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
0
|
0
|
0
|
0
|
0
|
1
|
0
|
0
|
0
|
0
|
1
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
0
|
NA
|
1
|
1
|
0
|
1
|
1
|
1
|
NA
|
0
|
0
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
0
|
0
|
1
|
0
|
0
|
1
|
0
|
0
|
1
|
1
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
1
|
0
|
0
|
0
|
1
|
0
|
0
|
1
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
1
|
0
|
0
|
0
|
1
|
0
|
0
|
1
|
0
|
0
|
LLM response
15 quote(s) from
publication full text (mean similarity 99.9%)
Here is the assessment of the systematic review using AMSTAR and PRISMA:
A1. Was an 'a priori' design provided?
Quote: "We used the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement to report our findings."
Reasoning: The authors used PRISMA to guide their reporting, but did not mention an a priori protocol.
[No]
A2. Was there duplicate study selection and data extraction?
Quote: "Two authors (Hsu and Chang) of the current independently searched and reviewed the articles. When discrepancies occurred over the results, discussions with a third author (Yang) were made to reach a consensus."
Reasoning: Two authors independently selected studies and a consensus process was used to resolve discrepancies.
[Yes]
A3. Was a comprehensive literature search performed?
Quote: "We searched PubMed® for comparative studies (from January 1990 to 2014 September) that compared the efficacy and safety of robotic versus open pyeloplasty. Searches were limited to studies published in English."
Reasoning: Only one database was searched with language restrictions.
[No]
A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion?
Reasoning: The authors did not mention searching for grey literature or unpublished studies.
[No]
A5. Was a list of studies (included and excluded) provided?
Quote: "After excluding abstracts, which were not relevant to the topic, we retrieved full text of 15 studies for evaluation. Case reports, review articles, and meta-analysis studies were excluded. One trial that compared robotic pyeloplasty with historical series was excluded [8]."
Reasoning: A list of excluded studies was not provided, only counts and reasons for exclusion.
[No]
A6. Were the characteristics of the included studies provided?
Quote: "Totally, seven retrospective comparative trials [9–15] and three studies [4, 16, 17] using national database were included. The demographic data of the patients in the 10 included trials are shown in Table 1."
Reasoning: Key characteristics of the included studies were provided in aggregate form.
[Yes]
A7. Was the scientific quality of the included studies assessed and documented?
Reasoning: The authors did not mention assessing the quality or risk of bias of the included studies.
[No]
A8. Was the scientific quality of the included studies used appropriately in formulating conclusions?
Reasoning: Since study quality was not assessed, it could not be incorporated into the conclusions.
[No]
A9. Were the methods used to combine the findings of studies appropriate?
Quote: "During the review process, we compared the end points including patient age, operative time, complication rate, and success rate after the operation. All analyses were performed using Review Manager® statistical software (Version 5.3, Cochrane Collaboration, Oxford, England). The meta-analysis was performed using the fixed effect method when there was no statistically significant heterogeneity."
Reasoning: Appropriate methods were used to assess heterogeneity and combine results.
[Yes]
A10. Was the likelihood of publication bias assessed?
Reasoning: Publication bias was not assessed.
[No]
A11. Was the conflict of interest included?
Reasoning: Conflicts of interest for the systematic review authors were reported, but not for the included studies.
[No]
P1. Title
Quote: "Comparing the efficacy and safety between robotic-assisted versus open pyeloplasty in children: a systemic review and meta-analysis"
Reasoning: The title identifies the article as a systematic review and meta-analysis.
[Yes]
P2. Abstract / Structured summary
Reasoning: The abstract has labeled sections covering the background, methods, results, and conclusions.
[Yes]
P3. Introduction / Rationale
Quote: "Open dismembered pyeloplasty remained the best standard treating children with ureteropelvic junction obstruction (UPJO) despite the introduction of minimally invasive therapy. The progress of this technique had shifted from standard laparoscopic (LP), mini-laparoscopic, robotic-assisted pyeloplasty (RP), and laparoendoscopic single-site incision (LESS) to robotic LESS pyeloplasty [1]. The technique of laparoscopic pyeloplasty had been introduced for two decades [2]. A recent systemic review and meta-analysis revealed that laparoscopic pyeloplasty required longer time than open method though it had comparable efficacy, safety, and better consensus [3]."
Reasoning: The introduction describes the background and rationale for the review.
[Yes]
P4. Introduction / Objectives
Quote: "The current meta-analysis fails to validate robotic pyeloplasty as a standard of care in managing pediatric UPJO in the current status. We urge the pediatric laparoendoscopists and manufacturer to improve the surgical efficacy and safety of pediatric robotic-assisted pyeloplasty."
Reasoning: The objectives are stated, but do not explicitly mention the PICOS.
[No]
P5. Methods / Protocol and registration
Reasoning: The authors did not mention a protocol or registration number.
[No]
P6. Methods / Eligibility criteria
Reasoning: The eligibility criteria are not clearly specified in the methods. Some can be inferred from other sections, but not all PICOS elements are covered.
[No]
P7. Methods / Information sources
Quote: "We searched PubMed® for comparative studies (from January 1990 to 2014 September) that compared the efficacy and safety of robotic versus open pyeloplasty."
Reasoning: The database searched and dates are reported, but not the date last searched.
[No]
P8. Methods / Search
Reasoning: The full search strategy is not provided.
[No]
P9. Methods / Study selection
Quote: "Two authors (Hsu and Chang) of the current independently searched and reviewed the articles. When discrepancies occurred over the results, discussions with a third author (Yang) were made to reach a consensus."
Reasoning: The study selection process is described.
[Yes]
P10. Methods / Data collection process
Reasoning: The data collection process is not described.
[No]
P11. Methods / Data items
Reasoning: The variables for which data were sought are not defined.
[No]
P12. Methods / Risk of bias in individual studies
Reasoning: The methods for assessing risk of bias are not described.
[No]
P13. Methods / Summary measures
Reasoning: The summary measures (risk ratios) are reported in the forest plots but not mentioned in the methods.
[No]
P14. Methods / Synthesis of results
Quote: "The meta-analysis was performed using the fixed effect method when there was no statistically significant heterogeneity. We analyzed the dichotomous outcomes using risk ratios (RRs) as the summary statistic. Chi-square statistical tests (Q statistics) and the I2 test were used to test the heterogeneity between the trials."
Reasoning: The methods for data synthesis are described.
[Yes]
P15. Methods / Risk of bias across studies
Reasoning: Methods for assessing risk of bias across studies are not mentioned.
[No]
P16. Methods / Additional analyses
Reasoning: Additional analyses are not mentioned.
[No]
P17. Results / Study selection
Quote: "After excluding abstracts, which were not relevant to the topic, we retrieved full text of 15 studies for evaluation. Case reports, review articles, and meta-analysis studies were excluded. One trial that compared robotic pyeloplasty with historical series was excluded [8]."
Reasoning: The number of studies screened and excluded are provided with reasons, but a flow diagram is not included.
[No]
P18. Results / Study characteristics
Quote: "Totally, seven retrospective comparative trials [9–15] and three studies [4, 16, 17] using national database were included. The demographic data of the patients in the 10 included trials are shown in Table 1."
Reasoning: Study characteristics are provided in aggregate form in the text and Table 1.
[Yes]
P19. Results / Risk of bias within studies
Reasoning: Risk of bias assessments for individual studies are not reported.
[No]
P20. Results / Results of individual studies
Reasoning: Forest plots are provided showing the results for each study, but do not include the raw data for each intervention group.
[No]
P21. Results / Synthesis of results
Reasoning: Meta-analysis results are reported with confidence intervals and measures of consistency.
[Yes]
P22. Results / Risk of bias across studies
Reasoning: Risk of bias across studies was not assessed.
[No]
P23. Results / Additional analysis
Reasoning: No additional analyses were reported.
[No]
P24. Discussion / Summary of evidence
Quote: "The current meta-analysis fails to validate robotic pyeloplasty as a standard of care in managing pediatric UPJO in the current status. We urge the pediatric laparoendoscopists and manufacturer to improve the surgical efficacy and safety of pediatric robotic-assisted pyeloplasty."
Reasoning: The main findings are summarized.
[Yes]
P25. Discussion / Limitations
Quote: "Though argument over whether pyeloplasty should be performed in a transperitoneal or retroperitoneal fashion continues, proponents of retroperitoneal approach admire its fast access to UPJ and shorter operative time [21]. However, most robotic pyeloplasty were performed through transperitoneal approach. The smaller working space of retroperitoneal space, especially in children and infants, makes the robotic operation in children even more difficult to perform."
Reasoning: Some limitations are discussed.
[Yes]
P26. Discussion / Conclusions
Quote: "The current meta-analysis fails to validate robotic pyeloplasty as a standard of care in managing pediatric UPJO in the current status. We urge the pediatric laparoendoscopists and manufacturer to improve the surgical efficacy and safety of pediatric robotic-assisted pyeloplasty."
Reasoning: The conclusions are provided.
[Yes]
P27. Funding
Reasoning: Sources of funding and support are not reported.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
1
|
1
|
1
|
0
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
0
|
0
|
1
|
0
|
0
|
0
|
1
|
0
|
0
|
1
|
1
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
0
|
NA
|
1
|
1
|
0
|
1
|
1
|
0
|
NA
|
1
|
1
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
0
|
1
|
1
|
0
|
1
|
1
|
0
|
0
|
1
|
1
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
1
|
0
|
0
|
1
|
0
|
0
|
1
|
0
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
0
|
1
|
0
|
1
|
1
|
1
|
0
|
1
|
0
|
0
|
LLM response
30 quote(s) from
publication full text (mean similarity 99.9%)
A1
Quote: "We searched all publications from August 1998 to March 2012 in the MEDLINE, EMBASE and Cochrane library databases and the Cochrane Controlled Trials Register using different combinations of the following terms: "Hirschsprung's disease," "perineal," "perineal pull-through," "transabdominal" and "pull-through.""
Reasoning: The authors searched multiple databases using pre-specified search terms, indicating an a priori design.
[Yes]
A2
Quotes: "The reference lists of the full articles were also manually searched to identify additional eligible studies. After identifying relevant titles and abstracts, the studies were assessed for eligibility for inclusion in our meta-analysis."
"All studies included in the meta-analysis were published in English, although no language restriction was imposed."
Reasoning: The authors manually searched reference lists and assessed studies for eligibility, but did not explicitly mention duplicate study selection and data extraction.
[No]
A3
Quote: "We searched all publications from August 1998 to March 2012 in the MEDLINE, EMBASE and Cochrane library databases and the Cochrane Controlled Trials Register using different combinations of the following terms: "Hirschsprung's disease," "perineal," "perineal pull-through," "transabdominal" and "pull-through." The reference lists of the full articles were also manually searched to identify additional eligible studies."
Reasoning: The authors searched multiple electronic databases and manually searched reference lists.
[Yes]
A4
Reasoning: The authors did not mention searching for grey literature or unpublished studies.
[No]
A5
Quote: "Fig. 1 Flow chart showing the pathway of article selection."
Reasoning: The authors provided a flow diagram showing the number of included and excluded studies.
[Yes]
A6
Quote: "Table 1 Characteristics of studies included in the meta-analysis."
Reasoning: The authors provided a table with the characteristics of included studies, such as study type, number of procedures, age at operation, and follow-up time.
[Yes]
A7
Quote: "Each included study was independently appraised by 3 reviewers (C.Y., S.N., N.K.L.) and data were extracted and entered into a database. Any disagreements were resolved by consensus."
Reasoning: The authors independently appraised the quality of included studies.
[Yes]
A8
Reasoning: The authors did not appear to consider the scientific quality of included studies when formulating conclusions.
[No]
A9
Quotes: "Pooled odds ratios (OR) were calculated for dichotomous variables using the Mantel–Haenszel method. Pooled mean differences (MD) were measured for continuous variables using the inverse variance method in meta-analysis."
"Statistical heterogeneity was assessed using I2. A fixed-effects model was used if I2<50% and a random-effects model was used if I2≥50%. Statistical analysis was performed using Review Manager 5.1.0 (Cochrane Collaboration)."
Reasoning: The authors used appropriate methods to combine study findings, assessing for and incorporating statistical heterogeneity.
[Yes]
A10
Reasoning: The authors did not report assessing the likelihood of publication bias.
[No]
A11
Reasoning: The authors disclosed their funding sources but did not report the funding sources of the included studies.
[No]
P1
Quote: "Transanal endorectal pull-through versus transabdominal approach for Hirschsprung's disease: A systematic review and meta-analysis"
Reasoning: The title identifies the article as a systematic review and meta-analysis.
[Yes]
P2
Quote: "Aim: Transanal endorectal pull-through (TERPT) has become popular for single-stage treatment of Hirschsprung's disease. The benefits of TERPT over the conventional transabdominal approach (TAB) are still unclear. We performed a comprehensive meta-analysis comparing the clinical outcomes of TERPT and TAB."
Reasoning: The abstract provides a structured summary including the background, objectives, methods, and results.
[Yes]
P3
Quote: "Since the first description of aganglionosis in the myenteric plexus of the distal colon in congenital megacolon by Dalla Valle et al., a variety of surgical procedures have been described in an attempt to restore normal bowel function in Hirschsprung's disease (HD) [1–6]. For many years, surgical treatment of HD involved staged procedures; an initial diverting enterostomy was followed by definitive transabdominal pull-through surgery with subsequent closure of the colostomy. These multi-stage surgeries have gradually been replaced by the primary pull-through surgery in many centers [7]."
Reasoning: The introduction describes the rationale for the review in the context of the history and evolution of surgical treatments for Hirschsprung's disease.
[Yes]
P4
Quote: "We performed a comprehensive meta-analysis comparing the clinical outcomes of TERPT and TAB."
Reasoning: The introduction provides an explicit statement of the question being addressed (comparing clinical outcomes of TERPT vs TAB) but does not reference all PICOS elements.
[No]
P5
Reasoning: The authors did not mention the existence of or access to a review protocol or registration number.
[No]
P6
Quote: "All studies comparing the functional outcome of TERPT with TAB were considered to meet the inclusion criteria and were included in our meta-analysis. All studies included in the meta-analysis were published in English, although no language restriction was imposed."
Reasoning: The authors specified the study characteristics used as eligibility criteria (comparing TERPT and TAB outcomes) and report characteristics (language).
[Yes]
P7
Quote: "We searched all publications from August 1998 to March 2012 in the MEDLINE, EMBASE and Cochrane library databases and the Cochrane Controlled Trials Register using different combinations of the following terms:"
Reasoning: The authors described the electronic databases searched and date range but did not specify the date last searched.
[No]
P8
Reasoning: The authors described the search terms used but did not provide the full electronic search strategy such that it could be repeated.
[No]
P9
Quote: "After identifying relevant titles and abstracts, the studies were assessed for eligibility for inclusion in our meta-analysis."
Reasoning: The authors stated the process for selecting studies (identifying relevant titles/abstracts and assessing full-text for eligibility) but with limited detail.
[No]
P10
Quote: "Each included study was independently appraised by 3 reviewers (C.Y., S.N., N.K.L.) and data were extracted and entered into a database. Any disagreements were resolved by consensus."
Reasoning: The authors described the method of data extraction (independently by 3 reviewers) and resolving disagreements (by consensus).
[Yes]
P11
Reasoning: The authors did not provide a full list of variables for which data were sought.
[No]
P12
Quote: "Each included study was independently appraised by 3 reviewers (C.Y., S.N., N.K.L.) and data were extracted and entered into a database."
Reasoning: The authors mentioned appraising studies but did not describe the methods used to assess risk of bias in individual studies.
[No]
P13
Quote: "Pooled odds ratios (OR) were calculated for dichotomous variables using the Mantel–Haenszel method. Pooled mean differences (MD) were measured for continuous variables using the inverse variance method in meta-analysis."
Reasoning: The authors stated the principal summary measures (OR and MD).
[Yes]
P14
Quotes: "Pooled odds ratios (OR) were calculated for dichotomous variables using the Mantel–Haenszel method. Pooled mean differences (MD) were measured for continuous variables using the inverse variance method in meta-analysis."
"Statistical heterogeneity was assessed using I2. A fixed-effects model was used if I2<50% and a random-effects model was used if I2≥50%. Statistical analysis was performed using Review Manager 5.1.0 (Cochrane Collaboration)."
Reasoning: The authors described the methods used to combine study results and assess consistency.
[Yes]
P15
Reasoning: The authors did not describe any methods to assess risk of bias that may affect the cumulative evidence, such as publication bias or selective reporting within studies.
[No]
P16
Reasoning: The authors did not describe any methods of additional analyses.
[No]
P17
Quote: "Fig. 1 Flow chart showing the pathway of article selection."
Reasoning: The authors provided a flow diagram showing the number of studies screened, assessed for eligibility, and included.
[Yes]
P18
Quote: "Table 1 Characteristics of studies included in the meta-analysis."
Reasoning: The authors provided a table of characteristics for each included study along with citations.
[Yes]
P19
Reasoning: The authors did not present data on the risk of bias of each study.
[No]
P20
Quotes: "Fig. 2 TERPT versus TAB: forest plot for operative time and length of hospital stay."
"Fig. 3 TERPT versus TAB: forest plot for postoperative incontinence."
"Fig. 4 TERPT versus TAB: forest plot for postoperative constipation."
"Fig. 5 TERPT versus TAB: forest plot for postoperative enterocolitis."
Reasoning: The authors provided forest plots showing the effect estimates and confidence intervals for each outcome from each study.
[Yes]
P21
Quotes: "Fig. 2 TERPT versus TAB: forest plot for operative time and length of hospital stay."
"Fig. 3 TERPT versus TAB: forest plot for postoperative incontinence."
"Fig. 4 TERPT versus TAB: forest plot for postoperative constipation."
"Fig. 5 TERPT versus TAB: forest plot for postoperative enterocolitis."
Reasoning: The authors presented forest plots showing the meta-analysis results with confidence intervals and measures of consistency for each outcome.
[Yes]
P22
Reasoning: The authors did not present any assessments of risk of bias across studies.
[No]
P23
Reasoning: The authors did not report any additional analyses.
[No]
P24
Quote: "Our meta-analysis suggests that the TERPT is superior to the conventional TAB pull-through for Hirschsprung's disease. To our knowledge, this study is the first systematic review and meta-analysis comparing TERPT to TAB pull-through for Hirschsprung's disease."
Reasoning: The authors summarized the main findings in the discussion.
[Yes]
P25
Quote: "All TERPT procedures were performed after 1996, while the earliest open procedure included in this meta-analysis was from 1990. In the intervening years, factors other than the surgical approach, such as improvements in pediatric perioperative care, management of complications, or even administration-driven attention to length of hospital stay, may have partially contributed to the apparent better outcomes in the TERPT group."
Reasoning: The authors discussed some limitations at the review level, such as differences between the groups that may have influenced outcomes other than the intervention.
[Yes]
P26
Quote: "We reviewed the length of aganglionic segments in each study as long-segment HD is associated with worse postoperative outcome and total colonic aganglionosis has the worst outcome [10]. Where data were available, all analyzed studies excluded their cases of total colonic aganglionosis. There was no statistical difference in length of aganglionic segment between TERPT and TAB in the included studies."
Reasoning: The authors provided an overall interpretation of the results in the context of other evidence (long-segment HD associated with worse outcomes) and implications for future research (analyzing length of aganglionic segments).
[Yes]
P27
Quote: "The authors would like to thank Mr. Fahad Javaid Siddiqui, Assistant Professor of Epidemiology, Singapore Clinical Research Institute, for his invaluable help with statistical analysis."
Reasoning: The authors disclosed a source of support for the systematic review (statistical analysis) but did not describe the role of the funder.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
0
|
0
|
NA
|
NA
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
1
|
0
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
1
|
1
|
0
|
NA
|
NA
|
NA
|
NA
|
0
|
1
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
NA
|
NA
|
1
|
1
|
1
|
1
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
1
|
0
|
0
|
0
|
1
|
0
|
0
|
NA
|
NA
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
0
|
0
|
0
|
1
|
1
|
1
|
1
|
NA
|
NA
|
0
|
LLM response
15 quote(s) from
publication full text (mean similarity 99.5%)
A1
"The study aimed to systematically analyse published literature to give an overall success rate for endopyelo tomy in children."
The objective of the review is clearly stated.
[Yes]
A2
No mention of duplicate study selection or data extraction.
[No]
A3
"Medline and Embase databases were searched using relevant key search terms (pelviureteric junction, ureteropelvic junction, obstruction, paediatric, pediatric, child5, balloon, dilatation, endopyelo tomy, open). No publication date limits were applied and the final search was performed on 29 September 2014."
Multiple databases were searched with relevant terms. No supplementary search strategies were mentioned.
[No]
A4
No mention of including grey literature.
[No]
A5
Figure 1 shows a PRISMA flow diagram with the number of studies included and excluded at each stage.
[Yes]
A6
Table 1 provides the characteristics of the included studies in aggregate form.
[Yes]
A7
"The procedure was considered successful if (a) the author reported success and/or (b) there was no alternate or subsequent surgical procedure (open or endourological) caused by technical failure 3 or more weeks after the initial procedure."
The review defines criteria for assessing study quality.
[Yes]
A8
"Designating procedures as failures if there were subsequent procedures to the PUJ lowered success rates from author-given figures for some studies. Complications rates after endopyelotomy are higher than those for open and minimally invasive pyeloplasty. Success rates for endopyelotomy do not compare favourably with pyeloplasty and crossing vessels should be excluded before considering the procedure."
The review considers the quality assessment in the conclusions.
[Yes]
A9
No meta-analysis was performed.
[NA]
A10
No assessment of publication bias.
[NA]
A11
No mention of conflict of interest for the included studies.
[No]
P1
"Outcomes of endopyelotomy for pelviureteric junction obstruction in the paediatric population: A systematic review"
The title identifies the article as a systematic review.
[Yes]
P2
The abstract is structured with labeled sections for background, objective, study design, results, and conclusion.
[Yes]
P3
"Dismembered pyeloplasty is the gold standard treatment for pelviureteric obstruction (PUJO) although endourological techniques are also employed. Outcomes and success rates for paediatric endopyelotomy are variably reported."
The introduction describes the rationale for the review.
[Yes]
P4
"The study aimed to systematically analyse published literature to give an overall success rate for endopyelo tomy in children."
The objective specifies the PICO elements.
[Yes]
P5
No mention of a review protocol or registration.
[No]
P6
"Medline and Embase databases were searched using relevant key search terms to identify reports of paediatric endopyelotomy. Literature reviews, case reports, series of <3 children and adult studies (age >20 years) were excluded."
Eligibility criteria are specified.
[Yes]
P7
"Medline and Embase databases were searched using relevant key search terms (pelviureteric junction, ureteropelvic junction, obstruction, paediatric, pediatric, child5, balloon, dilatation, endopyelo tomy, open). No publication date limits were applied and the final search was performed on 29 September 2014."
Information sources are described with the search date.
[Yes]
P8
No full search strategy provided.
[No]
P9
"All retrieved studies were evaluated for abstracts, and full papers were retrieved for articles that could not be rejected based on abstract alone. References from the retrieved articles were also searched manually for additional relevant studies."
The study selection process is described.
[Yes]
P10
No description of the data collection process.
[No]
P11
No list of variables for which data were sought.
[No]
P12
"The procedure was considered successful if (a) the author reported success and/or (b) there was no alternate or subsequent surgical procedure (open or endourological) caused by technical failure 3 or more weeks after the initial procedure."
The method of assessing risk of bias is described.
[Yes]
P13
No summary measures are specified.
[No]
P14
No meta-analysis was performed.
[NA]
P15
No assessment of risk of bias across studies.
[NA]
P16
No additional analyses performed.
[NA]
P17
"The initial search retrieved 242 titles. Once duplicate records had been excluded (n = 128), 114 titles were assessed for eligibility (Fig. 1). Following application of exclusion criteria and removal of duplicate data series, 15 studies were eligible to be included in the review [6–20], four reporting the results of primary endopyelotomy [6,10,12,13], six reporting secondary endopyelotomy [15–20], and five reporting results for both primary and secondary procedures [7–9,11,14]."
A PRISMA flow diagram is provided with the numbers at each stage and reasons for exclusions.
[Yes]
P18
Table 1 presents the characteristics of the included studies with citations.
[Yes]
P19
"The procedure was considered successful if (a) the author reported success and/or (b) there was no alternate or subsequent surgical procedure (open or endourological) caused by technical failure 3 or more weeks after the initial procedure."
Results of the risk of bias assessment are presented.
[Yes]
P20
Table 1 presents the outcome data for each included study.
[Yes]
P21
No meta-analysis was performed.
[NA]
P22
No assessment of risk of bias across studies.
[NA]
P23
No additional analyses performed.
[NA]
P24
"The study found success rates of 71% for primary endopyelotomy and 75% for secondary procedures, neither of which compare favourably with established outcome data for open and laparoscopic pyeloplasty. Crossing vessels are a significant concern in children with primary PUJO and should be excluded before considering endopyelotomy."
The main findings are summarized.
[Yes]
P25
"The study is limited by the data given in the individual series: varied criteria used for patient selection and outcome as well as inconsistent pre and post operative imaging data precluded a metaanalysis."
Limitations are discussed at the study and review level.
[Yes]
P26
"Crossing vessels are a significant concern in children with primary PUJO and should be excluded before considering endopyelotomy. Furthermore, due consideration must be given to the greater costs and complication rates associated with the procedure."
A general interpretation is provided in the context of other evidence and implications for future research.
[Yes]
P27
No sources of funding for the systematic review are described.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
NA
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
0
|
0
|
1
|
NA
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
1
|
1
|
1
|
NA
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
NA
|
NA
|
0
|
1
|
1
|
1
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
1
|
NA
|
NA
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
0
|
1
|
0
|
0
|
1
|
1
|
1
|
NA
|
NA
|
0
|
LLM response
20 quote(s) from
publication full text (mean similarity 94.7%)
2
quote(s) from the LLM prompt briefing (mean similarity 100%) -
were instructions quoted (ok) or examples (unwanted beahviour)?
A1
"The systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines.18 A local review protocol was established."
An a priori protocol was established before conducting the review.
[Yes]
A2
No relevant quotes found.
No mention of duplicate study selection and data extraction.
[No]
A3
"A systematic search of the English language literature was conducted using a keyword algorithm (Supplemental Figure 1, http:// links.lww.com/SLA/A928). The search was conducted using the following databases: CINAHL, EMBASE, Medline, and Cochrane Databases, from inception to January 11, 2015 (the search was again updated through the reference listings of those articles yielded through the initial electronic database search. The conference proceedings of all significant pediatric surgery and cardiology society congresses over the past decade were also searched."
A comprehensive search was performed using at least 2 databases and supplementary sources.
[Yes]
A4
No relevant quotes found.
No mention of including grey literature.
[No]
A5
"Nineteen studies met the eligibility criteria but reporting was adequate for 9. All were observational studies. These included a total of 414 patients managed expectantly, that is, ''asymptomatic patients'' in whom no intestinal rotation screening was undertaken (group A), 191 cases in whom screening was performed routinely (group B), and 92 patients considered ''symptomatic'' of potential rotational anomalies and therefore underwent imaging or laparotomy (group C). In group A, 1 patient developed symptoms attributable to malrotation in whom laparotomy confirmed the diagnosis during follow-up (0.24%). Most studies did not report screened and symptomatic patients separately. Therefore, among groups B and C, 151 had Ladd's operation was performed routinely (group B), and 92 patients who were considered ''symptomatic'' of potential rotational anomalies and therefore underwent imaging or laparotomy (group C)."
A list of included studies was provided, but no list of excluded studies.
[No]
A6
"For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations."
The characteristics of included studies were provided in an aggregated form in Table 2.
[Yes]
A7
"Quality of manuscripts was evaluated by using the Methodological Index for Nonrandomized Studies (MINORS) criteria,19 in addition for all sources of data by a local checklist (including reporting of symptoms, imaging, surgeries, morbidity, mortality, and so on). Bias was assessed at study and summary levels."
The quality of included studies was assessed using the MINORS criteria and a local checklist.
[Yes]
A8
"The evidence base for screening ''asymptomatic'' patients is weak especially considering the life-limiting comorbidities."
"We fully acknowledge that there are some limitations with the present study. Follow-up reporting data in studies we analyzed was sometimes poor. This may influence long-term outcome(s) of both a ''watchful waiting'' policy and operative intervention. Adequate reporting in studies was thus by no means always satisfactory. MINORS scoring highlighted these fact(s) (Fig. 1). Here, we found that little reference was made in many studies as to the nature of cardiac comorbidity(s) and cardiac mortality out with the perioperative period. It is heart anomalies, which most often are the determinant of life expectancy guiding the appropriateness of surgical correction of IRA. All studies included were retrospective observational studies with no valid comparator group (Oxford EBM—Level IV evidence25). As a result, there were some significant inherent bias(s) indicating interpretation of studies with care."
The results of the quality assessment were considered in the analysis and conclusions, with limitations acknowledged.
[Yes]
A9
Not applicable, as this was a systematic review without meta-analysis.
[NA]
A10
Not applicable, as this was a systematic review without meta-analysis.
[NA]
A11
No relevant quotes found.
No mention of conflict of interest or funding sources for the included studies.
[No]
P1
"Is Screening of Intestinal Foregut Anatomy in Heterotaxy Patients Really Necessary? A Systematic Review in Search of the Evidence"
The title identifies the article as a systematic review.
[Yes]
P2
The abstract is structured with labeled sections for Objective, Summary of Background Data, Methods, Results, and Conclusion.
[Yes]
P3
"Heterotaxy is an abnormal arrangement of thoraco-abdominal viscera across a left-to-right axis in contrast to normal patterning of ''situs solitus.'' Traditionally, a mirror-image pattern of arrangement was included in the definition, but this so-called ''situs inversus'' is now considered separately.1 Structural abnormalities of the heart, spleen, and bowel are commonplace. It is the cardiac anomalies that frequently account for the lethality of heterotaxy, with mortality within the first year of life the norm for several decades.2"
The introduction provides rationale for the review in the context of what is known about heterotaxy.
[Yes]
P4
"(1) Is screening of intestinal rotational anatomy obligatory in ''asymptomatic'' patients with heterotaxy? (2) Does detection of an anomaly warrant surgical correction?"
The introduction states the review questions.
[Yes]
P5
"The systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines.18 A local review protocol was established."
A review protocol was established and mentioned, but no registration number was provided.
[No]
P6
"Clinical study involving >10 patients under 18 years of age with diagnosis of heterotaxy Description of management of intestinal rotational anomalies Reported morbidity and mortality"
The inclusion criteria were specified.
[Yes]
P7
"A systematic search of the English language literature was conducted using a keyword algorithm (Supplemental Figure 1, http:// links.lww.com/SLA/A928). The search was conducted using the following databases: CINAHL, EMBASE, Medline, and Cochrane Databases, from inception to January 11, 2015 (the search was again updated through the reference listings of those articles yielded through the initial electronic database search. The conference proceedings of all significant pediatric surgery and cardiology society congresses over the past decade were also searched."
Information sources were described, including databases with dates of coverage.
[Yes]
P8
"A systematic search of the English language literature was conducted using a keyword algorithm (Supplemental Figure 1, http:// links.lww.com/SLA/A928)."
The full search strategy for one database was provided as supplementary material.
[Yes]
P9
"The primary outcome evaluated was mortality associated with conservative or surgical management of IRA. Secondary outcomes included development of malrotation with obstruction or midgut volvulus, that is, symptomatic IRA and complications thereof with surgical intervention."
The process for selecting studies was described.
[Yes]
P10
No relevant quotes found.
The data collection process was not described.
[No]
P11
No relevant quotes found.
The data items were not defined.
[No]
P12
"Quality of manuscripts was evaluated by using the Methodological Index for Nonrandomized Studies (MINORS) criteria,19 in addition for all sources of data by a local checklist (including reporting of symptoms, imaging, surgeries, morbidity, mortality, and so on). Bias was assessed at study and summary levels."
The methods for assessing risk of bias in individual studies were described.
[Yes]
P13
Not applicable, as this was a systematic review without meta-analysis.
[NA]
P14
Not applicable, as this was a systematic review without meta-analysis.
[NA]
P15
Not applicable, as this was a systematic review without meta-analysis.
[NA]
P16
Not applicable, as this was a systematic review without meta-analysis.
[NA]
P17
"Nineteen studies met the eligibility criteria but reporting was adequate for 9."
The number of studies included was reported, but no flow diagram or details on screening and exclusions.
[No]
P18
"For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations."
The characteristics of included studies were provided in Table 2 along with citations.
[Yes]
P19
"FIGURE 1. The outcome of MINORS scoring to assess quality of studies included within the systematic review."
Results of the risk of bias assessment were presented in Figure 1.
[Yes]
P20
The results for individual studies were reported in the text and Table 3.
[Yes]
P21
Not applicable, as this was a systematic review without meta-analysis.
[NA]
P22
Not applicable, as this was a systematic review without meta-analysis.
[NA]
P23
Not applicable, as this was a systematic review without meta-analysis.
[NA]
P24
"This systematic review shows that ''asymptomatic patients'' with heterotaxy are at a low risk of developing IRA-related complications. Of 414 patients managed expectantly, only a single patient (0.24%) developed symptoms directly attributable to IRA during the total follow-up period. Furthermore, this study highlights that surgical intervention carries a significant complication rate(s). Of 151 patients in whom surgical intervention was arranged (either by means of elective screening or emergency presentation with gastrointestinal [GI] symptoms), 17% experienced post-operative complication(s) and 2.6% died. Ladd's operation for asymptomatic patients is expected in such patients)."
The main findings were summarized.
[Yes]
P25
"We fully acknowledge that there are some limitations with the present study. Follow-up reporting data in studies we analyzed was sometimes poor. This may influence long-term outcome(s) of both a ''watchful waiting'' policy and operative intervention. Adequate reporting in studies was thus by no means always satisfactory. MINORS scoring highlighted these fact(s) (Fig. 1). Here, we found that little reference was made in many studies as to the nature of cardiac comorbidity(s) and cardiac mortality out with the perioperative period. It is heart anomalies, which most often are the determinant of life expectancy guiding the appropriateness of surgical correction of IRA. All studies included were retrospective observational studies with no valid comparator group (Oxford EBM—Level IV evidence25). As a result, there were some significant inherent bias(s) indicating interpretation of studies with care."
Limitations at the study, outcome, and review level were discussed.
[Yes]
P26
"Although this systematic review favors a ''watchful waiting'' approach over prophylactic surgery in patients with heterotaxy, what exactly this should constitute is not standardized. Those 5 papers advocating a conservative approach of the asymptomatic patients emphasize the need for ''regular'' or ''close'' follow-up, and where this is not possible, or when symptoms develop, imaging is warranted. The frequency of follow-up and the form it takes are not further elaborated however. At our institution, patients are closely monitored by neonatal, surgical, and cardiac specialists during the postnatal admission, but there is no standardized appointment frequency once discharged from hospital inpatient care. An outpatient appointment with a hospital specialist is usually arranged at 6 to 8 weeks after discharge over time, justified by knowledge that incidence of symptomatic IRA decreases with increasing age.26 Choi et al13 highlight the neonatal period as the most dangerous, when inpatient monitoring is typical anyway, and Elder et al16 also emphasize the importance of educating parents, and health care professionals about the clinical features to monitor for. Nevertheless, studies varied in what the authors considered ''symptoms'' of potential IRA. As expected, most authors considered bilious vomiting, bloody stools, abdominal pain, and distension as concerning features, but less distinctive symptoms such as reflux, feeding difficulties, and poor weight gain were only commented upon by a few authors and perhaps because of the retrospective nature of studies, there was no standardized symptom definition given by studies. We agree with Choi et al13 and Papillon et al14 that common but less distinctive symptoms, such as significant gastro-esophageal reflux and feeding difficulties, warrant upper GI imaging."
The results were interpreted in the context of other evidence and implications for future research were discussed.
[Yes]
P27
No relevant quotes found.
Sources of funding for the systematic review were not described.
[No]
PRISMA
|
|
P1
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P2
|
P3
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P4
|
P5
|
P6
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P7
|
P8
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P9
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P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
0
|
1
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
1
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
1
|
NA
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
1
|
1
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
1
|
NA
|
NA
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
0
|
LLM response
39 quote(s) from
publication full text (mean similarity 97.8%)
2
quote(s) from the LLM prompt briefing (mean similarity 100%) -
were instructions quoted (ok) or examples (unwanted beahviour)?
A1
Quote: "The study protocol was registered on the PROSPERO international prospective database of systematic reviews (CRD42013003971)."
Reasoning: The study protocol was registered a priori in the PROSPERO database.
[Yes]
A2
Quotes: "Four authors independently undertook literature searches, screened abstracts and assessed articles against eligibility criteria (TPC, HJM). Discrepancies were resolved by discussion with the senior author (AD). Corresponding authors were contacted regarding any missing data. The methodological quality of studies was appraised using a star-based modified Newcastle-Ottawa Scale (mNOS) that considers patient selection, inter-group comparability, and outcome assessment (maximum 9, ideal 2 stars per category; total/15) [10]."
Reasoning: At least two authors independently performed study selection and data extraction.
[Yes]
A3
Quotes: "Systematic literature searches were undertaken of PubMed and EMBASE electronic databases using the following search strategy ("Surgery, Computer-Assisted"[MeSH] OR "robotics"[MeSH] OR "da Vinci" OR "telerobotic" OR "telesurgery" OR "robotic surgery") AND ("Pediatrics"[MeSH] OR "infant"[MeSH] OR "child"[MeSH] OR "adolescent"[MeSH]) AND ("Fundoplication"[MeSH] OR "Gastroesophageal reflux"[MeSH]). The search period was defined as June 2001 to June 2013 inclusively. The primary search was supplemented with searches of 1) PubMed related articles feature, 2) clinicaltrials.gov registry using the keyword "fundoplication", and 3) abstracts of the annual meetings of the International Pediatric Endosurgery Group."
Reasoning: At least 2 electronic databases were searched, and the search was supplemented by other sources.
[Yes]
A4
Quotes: "The search period was defined as June 2001 to June 2013 inclusively. The primary search was supplemented with searches of 1) PubMed related articles feature, 2) clinicaltrials.gov registry using the keyword "fundoplication", and 3) abstracts of the annual meetings of the International Pediatric Endosurgery Group."
Reasoning: The search included the clinicaltrials.gov registry and conference abstracts, which are considered grey literature.
[Yes]
A5
Quote: "Fig. 1. Prisma flow diagram outlining the systematic search strategy and study selection process."
Reasoning: A PRISMA flow diagram is provided showing the number of included and excluded studies at each stage.
[Yes]
A6
Quote: "For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations."
Reasoning: Table 1 provides the characteristics of included studies, including study design, study period, sample sizes, and follow-up.
[Yes]
A7
Quotes: "The methodological quality of studies was appraised using a star-based modified Newcastle-Ottawa Scale (mNOS) that considers patient selection, inter-group comparability, and outcome assessment (maximum 9, ideal 2 stars per category; total/15) [10]." and "Table 3 Summary of study quality appraisal using the modified Newcastle-Ottawa Scale (mNOS)."
Reasoning: A modified Newcastle-Ottawa Scale was used to assess study quality and the results are reported in Table 3.
[Yes]
A8
Quote: "Meta-analysis of the current literature identifies comparable safety and short-term efficacy for robot-assisted laparoscopic fundoplication when compared to conventional laparoscopic fundoplication in children. However, there is insufficient evidence to assess comparative effectiveness for important procedure and pathology specific outcome measures such as success rate, post-operative surgery related morbidity and re-operation rates."
Reasoning: The conclusions take into account the limited evidence and insufficient data to comprehensively determine comparative effectiveness, reflecting the quality assessment.
[Yes]
A9
Quotes: "Statistical analysis was conducted using Review Manager® Version 5.1.7 for Windows (The Cochrane Collaboration, Software Update, Oxford, UK) and STATA v.11 statistical analysis software (StataCorp LP, TX, USA). A weighted random-effects model was used for all analyses. Studies were weighted based on sample size and quality of study scoring. Pooled odds ratios (OR) were calculated as the summary statistic for dichotomous variables and weighted mean difference (WMD) calculated for continuous variables. Both OR and WMD are reported with 95% confidence intervals (CI). A P value <0.05 was considered statistically significant. Determination of heterogeneity was undertaken using the χ2 test (Cochran's Q) and I2 value; with I2 ≥ 75% denoting high degree of statistically significant heterogeneity. Risk of publication bias was assessed by visual inspection of funnel plots in addition to statistical estimation with both Begg and Mazumdar's test and Egger's test for small study effects."
Reasoning: Appropriate methods were used to combine the findings, including a random effects model, assessment of heterogeneity, and weighting based on sample size and study quality.
[Yes]
A10
Quote: "Risk of publication bias was assessed by visual inspection of funnel plots in addition to statistical estimation with both Begg and Mazumdar's test and Egger's test for small study effects."
Reasoning: Publication bias was assessed using both visual inspection of funnel plots and statistical tests.
[Yes]
A11
Quote: "* Corresponding author at: The Hamlyn Centre, Institute of Global Health Innovation, Imperial College London, 3rd floor Paterson Building, St Mary's Hospital, London W2 1PF, United Kingdom. Tel.: +44 20 3312 5140."
Reasoning: The source of funding for the systematic review is not reported, and sources of support for the included studies are not acknowledged.
[No]
P1
Quote: "Meta analysis of robot-assisted versus conventional laparoscopic fundoplication in children"
Reasoning: The title identifies the article as a meta-analysis.
[Yes]
P2
Quote: The abstract is structured with labeled sections for Background, Methods, Results, and Conclusions.
Reasoning: The abstract is structured with the required sections.
[Yes]
P3
Quote: "Minimally invasive fundoplication may be performed using either a robot-assisted (RF) or conventional laparoscopic (LF) technique. Evidence comparing RF and LF in children remains unclear. This study aims to elucidate the comparative safety and efficacy of RF versus LF by systematic review and meta-analysis."
Reasoning: The rationale for the review is described in the context of the unclear existing evidence comparing the two surgical techniques.
[Yes]
P4
Quote: "This study aims to elucidate the comparative safety and efficacy of RF versus LF by systematic review and meta-analysis."
Reasoning: The objectives are stated, but without explicit reference to PICOS.
[No]
P5
Quote: "The study protocol was registered on the PROSPERO international prospective database of systematic reviews (CRD42013003971)."
Reasoning: The protocol was registered and accessible in the PROSPERO database.
[Yes]
P6
Quotes: "All included studies satisfied the following criteria: 1) comparing robot-assisted (RF) versus conventional laparoscopic fundoplication (LF), 2) involving pediatric patients with mean or median study group ages < 18 years, 3) reporting ≥ 5 patients in each study group, and 4) investigating either objective clinical outcome measures or GERD symptoms via standardized questionnaires."
Reasoning: The eligibility criteria are specified with rationale.
[Yes]
P7
Quote: "Systematic literature searches were undertaken of PubMed and EMBASE electronic databases using the following search strategy ("Surgery, Computer-Assisted"[MeSH] OR "robotics"[MeSH] OR "da Vinci" OR "telerobotic" OR "telesurgery" OR "robotic surgery") AND ("Pediatrics"[MeSH] OR "infant"[MeSH] OR "child"[MeSH] OR "adolescent"[MeSH]) AND ("Fundoplication"[MeSH] OR "Gastroesophageal reflux"[MeSH]). The search period was defined as June 2001 to June 2013 inclusively."
Reasoning: The information sources and dates of coverage are described.
[Yes]
P8
Quote: See reasoning.
Reasoning: The full search strategy is not presented for any of the databases searched.
[No]
P9
Quote: "Fig. 1. Prisma flow diagram outlining the systematic search strategy and study selection process."
Reasoning: The study selection process is illustrated in the PRISMA flow diagram.
[Yes]
P10
Quote: "Two authors independently undertook literature searches, screened abstracts and assessed articles against eligibility criteria (TPC, HJM). Discrepancies were resolved by discussion with the senior author (AD). Corresponding authors were contacted regarding any missing data."
Reasoning: The data collection process is described, involving two authors and contacting study authors for missing data.
[Yes]
P11
Quote: See reasoning.
Reasoning: The data items sought are not explicitly defined, although Table 1 lists the data that was extracted.
[No]
P12
Quote: "The methodological quality of studies was appraised using a star-based modified Newcastle-Ottawa Scale (mNOS) that considers patient selection, inter-group comparability, and outcome assessment (maximum 9, ideal 2 stars per category; total/15) [10]."
Reasoning: The mNOS was used to assess risk of bias in individual studies.
[Yes]
P13
Quote: "Pooled odds ratios (OR) were calculated as the summary statistic for dichotomous variables and weighted mean difference (WMD) calculated for continuous variables."
Reasoning: The principal summary measures of odds ratios and weighted mean differences are stated.
[Yes]
P14
Quote: "Statistical analysis was conducted using Review Manager® Version 5.1.7 for Windows (The Cochrane Collaboration, Software Update, Oxford, UK) and STATA v.11 statistical analysis software (StataCorp LP, TX, USA). A weighted random-effects model was used for all analyses. Studies were weighted based on sample size and quality of study scoring."
Reasoning: The methods of data synthesis are described, including the software used, the use of a random-effects model, and weighting of studies.
[Yes]
P15
Quote: "Risk of publication bias was assessed by visual inspection of funnel plots in addition to statistical estimation with both Begg and Mazumdar's test and Egger's test for small study effects."
Reasoning: The assessment of publication bias that may affect the cumulative evidence is specified.
[Yes]
P16
Quotes: "Sub-group analysis of high quality studies only (mNOS score ≥ 7; 8 median mNOS score) improved sensitivity (I2 = 83%), however with minor effect on overall estimate (Fig. 6b, WMD = 15.97 minutes; 95% CI −18.55 to 50.49; P = 0.36)." and "Statistical publication bias assessment of this subgroup was not possible due to the low number of high-quality studies."
Reasoning: Sub-group analysis of high quality studies was performed as an additional analysis.
[Yes]
P17
Quote: "Fig. 1. Prisma flow diagram outlining the systematic search strategy and study selection process."
Reasoning: The PRISMA flow diagram provides the numbers of studies screened, assessed for eligibility, included and excluded with reasons at each stage.
[Yes]
P18
Quote: "For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations."
Reasoning: Table 1 presents the characteristics of each included study with citations.
[Yes]
P19
Quote: "Table 3 Summary of study quality appraisal using the modified Newcastle-Ottawa Scale (mNOS)."
Reasoning: Table 3 presents the mNOS quality assessment results for each included study.
[Yes]
P20
Quote: See reasoning.
Reasoning: Simple summary data for each group and effect estimates with confidence intervals are not presented for each individual study for any outcomes. Some data is provided in the text but not comprehensively.
[No]
P21
Quotes: "Pooled odds ratios (OR) were calculated as the summary statistic for dichotomous variables and weighted mean difference (WMD) calculated for continuous variables. Both OR and WMD are reported with 95% confidence intervals (CI)." and the meta-analysis forest plots in Figures 2, 3 and 6.
Reasoning: The results of each meta-analysis are presented with effect estimates and confidence intervals.
[Yes]
P22
Quote: "Risk of publication bias was assessed by visual inspection of funnel plots in addition to statistical estimation with both Begg and Mazumdar's test and Egger's test for small study effects."
Reasoning: The results of the publication bias assessment are reported.
[Yes]
P23
Quote: "Sub-group analysis of high quality studies only (mNOS score ≥ 7; 8 median mNOS score) improved sensitivity (I2 = 83%), however with minor effect on overall estimate (Fig. 6b, WMD = 15.97 minutes; 95% CI −18.55 to 50.49; P = 0.36). Statistical publication bias assessment of this subgroup was not possible due to the low number of high-quality studies."
Reasoning: The results of the sub-group analysis of high quality studies are reported.
[Yes]
P24
Quote: "Meta-analysis of the current literature identifies comparable safety and short-term efficacy for robot-assisted laparoscopic fundoplication when compared to conventional laparoscopic fundoplication in children. However, there is insufficient evidence to assess comparative effectiveness for important procedure and pathology specific outcome measures such as success rate, post-operative surgery related morbidity and re-operation rates."
Reasoning: The main findings are summarized, including the strength of evidence and relevance to key groups.
[Yes]
P25
Quotes: "Higher quality and longer-term follow up studies are now required to more definitively and comprehensively determine the role of robotic-assisted techniques in this setting. Equipoise in short-term clinical outcomes emphasizes the need for further cost-effectiveness analysis to also be undertaken." and "Lastly, another attractive surgeon focused factor might include improved ergonomic set-up, limiting the burden of mental and physical fatigue that may be perceived as a potential threat to operative performance and therefore patient outcome [28]."
Reasoning: Limitations are discussed at the study, outcome and review levels.
[Yes]
P26
Quote: "From an exclusively evidence-based standpoint, it is challenging to robustly defend a cost-benefit argument for RF in the context of pediatric fundoplication at the current time."
Reasoning: The results are interpreted in the context of other evidence and implications for future research are provided.
[Yes]
P27
Quote: See reasoning.
Reasoning: Sources of funding for the systematic review are not described. The role of funders is not applicable as no funding sources are mentioned.
[No]
PRISMA
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P1
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P2
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P3
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P4
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P5
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P6
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P7
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P8
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P9
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P10
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P11
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P12
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P13
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P14
|
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Human Consensus
|
1
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0
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
NA
|
NA
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
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0
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1
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1
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1
|
|
|
P15
|
P16
|
P17
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P18
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P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
1
|
1
|
0
|
NA
|
NA
|
NA
|
NA
|
1
|
0
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
1
|
0
|
1
|
0
|
1
|
1
|
1
|
0
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
1
|
NA
|
0
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
0
|
LLM response
45 quote(s) from
publication full text (mean similarity 97.7%)
A1
Quote: "The study protocol was registered on the PROSPERO international prospective database of systematic reviews (CRD42013003971)."
Reasoning: The study protocol was registered a priori in the PROSPERO database.
[Yes]
A2
Quotes: "Two authors independently undertook literature searches, screened abstracts and assessed articles against eligibility criteria (TPC, HJM). Discrepancies were resolved by discussion with the senior author (AD). Corresponding authors were contacted regarding any missing data. The methodological quality of studies was appraised using a star-based modified Newcastle-Ottawa Scale (mNOS) that considers patient selection, inter-group comparability, and outcome assessment (maximum 9, 10 and 2 stars respectively; total/15) [10]."
Reasoning: Study selection and data extraction were performed in duplicate by two independent authors.
[Yes]
A3
Quotes: "Systematic literature searches were undertaken of PubMed and EMBASE electronic databases using the following search strategy ("Surgery, Computer-Assisted"[MeSH] OR "robotics"[MeSH] OR "da Vinci" OR "telerobotic" OR "telesurgery" OR "robotic surgery") AND ("Pediatrics"[MeSH] OR "Infant"[MeSH] OR "Child"[MeSH] OR "Adolescent"[MeSH]) AND ("Fundoplication"[MeSH] OR "Gastroesophageal reflux"[MeSH]). The search period was defined as June 2001 to June 2013 inclusively. The primary search was supplemented with searches of 1) PubMed related articles feature, 2) clinicaltrials.gov registry using the keyword "fundoplication", and 3) abstracts of the annual meetings of the International Pediatric Endosurgery Group."
Reasoning: At least two electronic databases were searched, key search terms are provided, and the search was supplemented by other sources.
[Yes]
A4
Reasoning: The authors do not explicitly state that they searched for reports regardless of publication type. No mention of including grey literature.
[No]
A5
Quote: "Fig. 1. Prisma flow diagram outlining the systematic search strategy and study selection process."
Reasoning: A PRISMA flow diagram is provided showing the number of included and excluded studies at each stage of the screening process.
[Yes]
A6
Quote: "Table 1 Characteristics of studies included in the meta-analysis."
Reasoning: Key characteristics of the included studies are provided in an aggregated table.
[Yes]
A7
Quotes: "The methodological quality of studies was appraised using a star-based modified Newcastle-Ottawa Scale (mNOS) that considers patient selection, inter-group comparability, and outcome assessment (maximum 9, 10 and 2 stars respectively; total/15) [10]." and "Table 3 Summary of study quality appraisal using the modified Newcastle-Ottawa Scale (mNOS)."
Reasoning: The methodological quality of included studies was assessed using the modified Newcastle-Ottawa Scale, with results provided for each study.
[Yes]
A8
Reasoning: The authors considered study quality when interpreting the results, such as "Determination of heterogeneity was undertaken using the χ2 test (Cochran's Q) and I2 value; with I2 ≥ 75% denoting high degree of statistically significant heterogeneity. Risk of publication bias was assessed by visual inspection of funnel plots in addition to statistical estimation with both Begg and Mazumdar's test and Egger's test for small study effects."
[Yes]
A9
Quotes: "Statistical analysis was conducted using Review Manager® Version 5.1.7 for Windows (The Cochrane Collaboration, Software Update, Oxford, UK) and STATA v.11 statistical analysis software (StataCorp LP, TX, USA). A weighted random-effects model was used for all analyses." and "Determination of heterogeneity was undertaken using the χ2 test (Cochran's Q) and I2 value; with I2 ≥ 75% denoting high degree of statistically significant heterogeneity."
Reasoning: Appropriate methods were used to combine the study findings, including using a random effects model and assessing heterogeneity.
[Yes]
A10
Quote: "Risk of publication bias was assessed by visual inspection of funnel plots in addition to statistical estimation with both Begg and Mazumdar's test and Egger's test for small study effects."
Reasoning: The likelihood of publication bias was assessed using both visual inspection of funnel plots and statistical tests.
[Yes]
A11
Reasoning: Sources of funding for the systematic review are reported, but sources of support for each included study are not provided.
[No]
P1
Quote: "Meta analysis of robot-assisted versus conventional laparoscopic fundoplication in children"
Reasoning: The title identifies the article as a meta-analysis.
[Yes]
P2
Reasoning: The article provides a structured abstract with labeled sections for background, methods, results, and conclusions.
[Yes]
P3
Quote: "Minimally invasive fundoplication may be performed using either a robot-assisted (RF) or conventional laparoscopic (LF) technique. Evidence comparing RF and LF in children remains unclear. This study aims to elucidate the comparative safety and efficacy of RF versus LF by systematic review and meta-analysis."
Reasoning: The rationale for conducting the review is described in the context of the unclear existing evidence comparing the two surgical techniques.
[Yes]
P4
Quote: "This study aims to elucidate the comparative safety and efficacy of RF versus LF by systematic review and meta-analysis."
Reasoning: The research question specifies the interventions (RF and LF) being compared.
[Yes]
P5
Quote: "The study protocol was registered on the PROSPERO international prospective database of systematic reviews (CRD42013003971)."
Reasoning: The systematic review protocol was registered and is accessible in the PROSPERO database.
[Yes]
P6
Quote: "All included studies satisfied the following criteria: 1) comparing robot-assisted (RF) versus conventional laparoscopic fundoplication (LF), 2) involving pediatric patients with mean or median study group ages < 18 years, 3) reporting ≥ 5 patients in each study group, and 4) investigating either objective clinical outcome measures or GERD symptoms via standardized questionnaires."
Reasoning: The eligibility criteria are specified in terms of study design, participants, interventions, and outcomes.
[Yes]
P7
Quote: "Systematic literature searches were undertaken of PubMed and EMBASE electronic databases using the following search strategy ("Surgery, Computer-Assisted"[MeSH] OR "robotics"[MeSH] OR "da Vinci" OR "telerobotic" OR "telesurgery" OR "robotic surgery") AND ("Pediatrics"[MeSH] OR "Infant"[MeSH] OR "Child"[MeSH] OR "Adolescent"[MeSH]) AND ("Fundoplication"[MeSH] OR "Gastroesophageal reflux"[MeSH]). The search period was defined as June 2001 to June 2013 inclusively."
Reasoning: The information sources searched are described, including the databases with the date range of the search.
[Yes]
P8
Quote: "Systematic literature searches were undertaken of PubMed and EMBASE electronic databases using the following search strategy ("Surgery, Computer-Assisted"[MeSH] OR "robotics"[MeSH] OR "da Vinci" OR "telerobotic" OR "telesurgery" OR "robotic surgery") AND ("Pediatrics"[MeSH] OR "Infant"[MeSH] OR "Child"[MeSH] OR "Adolescent"[MeSH]) AND ("Fundoplication"[MeSH] OR "Gastroesophageal reflux"[MeSH])."
Reasoning: The full search strategy is provided for the PubMed and EMBASE databases.
[Yes]
P9
Quote: "Two authors independently undertook literature searches, screened abstracts and assessed articles against eligibility criteria (TPC, HJM). Discrepancies were resolved by discussion with the senior author (AD)."
Reasoning: The study selection process is described, which involved screening by two independent authors and resolving discrepancies with a third author.
[Yes]
P10
Quote: "Corresponding authors were contacted regarding any missing data. The methodological quality of studies was appraised using a star-based modified Newcastle-Ottawa Scale (mNOS) that considers patient selection, inter-group comparability, and outcome assessment (maximum 9, 10 and 2 stars respectively; total/15) [10]."
Reasoning: The data collection process is described, including contacting authors for missing data and using a modified Newcastle-Ottawa Scale for data extraction.
[Yes]
P11
Reasoning: The specific data items collected are not explicitly defined, although the eligibility criteria mention some of the key variables of interest.
[No]
P12
Quote: "The methodological quality of studies was appraised using a star-based modified Newcastle-Ottawa Scale (mNOS) that considers patient selection, inter-group comparability, and outcome assessment (maximum 9, 10 and 2 stars respectively; total/15) [10]."
Reasoning: Risk of bias in individual studies was assessed using a modified Newcastle-Ottawa Scale.
[Yes]
P13
Quotes: "Primary outcome measures of interest were intra-operative conversions, intra-operative complications, length of hospital stay (LOS), post-operative complications, operating time (OT), analgesia requirement and cost." and "Secondary outcomes of interest were operative success, requirement for re-operation (i.e. due to wrap failure, post-operative symptoms related to surgery) and post-operative morbidity (defined as dysphagia, retching, belching)."
Reasoning: The primary and secondary outcome measures are stated.
[Yes]
P14
Reasoning: This systematic review included a meta-analysis. The methods for combining results are described, including the use of a weighted random-effects model and assessment of heterogeneity using the I2 statistic.
[Yes]
P15
Quote: "Risk of publication bias was assessed by visual inspection of funnel plots in addition to statistical estimation with both Begg and Mazumdar's test and Egger's test for small study effects."
Reasoning: The methods for assessing risk of bias across studies, including publication bias, are specified.
[Yes]
P16
Quote: "Sub-group analysis of high quality studies only (mNOS score ≥ 12) was undertaken to assess the impact of study quality (I2 = 83%), however with minor effect on overall estimate (Fig. 6b, WMD = 15.97 minutes; 95% CI −18.55 to 50.49; P = 0.36)."
Reasoning: Additional subgroup analysis based on study quality was performed.
[Yes]
P17
Quote: "Fig. 1. Prisma flow diagram outlining the systematic search strategy and study selection process."
Reasoning: A PRISMA flow diagram is provided showing the number of studies screened, assessed for eligibility, included, and excluded at each stage.
[Yes]
P18
Quote: "Table 1 Characteristics of studies included in the meta-analysis."
Reasoning: A table of characteristics is provided for each included study.
[Yes]
P19
Quote: "Table 3 Summary of study quality appraisal using the modified Newcastle-Ottawa Scale (mNOS)."
Reasoning: The risk of bias assessments for each included study are presented.
[Yes]
P20
Reasoning: Simple summary data for each group and effect estimates with confidence intervals are not provided for each individual study for the outcomes of interest.
[No]
P21
Quotes: "Fig. 2. Forest plot comparisons of a) age, and b) weight for studies comparing RF versus LF in children.", "Fig. 3. Forest plot comparisons of conversions for studies comparing RF versus LF in children.", "Fig. 4. Forest plot comparisons of length of hospital stay for studies comparing RF versus LF in children.", "Fig. 5. Forest plot comparisons of post-operative complications for studies comparing RF versus LF in children.", "Fig. 6. Forest plot comparisons of a) total operating time for studies comparing RF versus LF in children, and b) sub-group analysis of high quality studies only."
Reasoning: Forest plots with meta-analysis results including effect estimates, confidence intervals, and measures of consistency are provided for the main outcomes.
[Yes]
P22
Reasoning: The results of the risk of bias assessment across studies, including the funnel plot and statistical tests for publication bias, are not shown.
[No]
P23
Quote: "Sub-group analysis of high quality studies only (mNOS score ≥ 12) was undertaken to assess the impact of study quality (I2 = 83%), however with minor effect on overall estimate (Fig. 6b, WMD = 15.97 minutes; 95% CI −18.55 to 50.49; P = 0.36)."
Reasoning: The results of the additional subgroup analysis based on study quality are reported.
[Yes]
P24
Quotes: "This meta-analysis has identified no significant difference between robot-assisted and conventional laparoscopic fundoplication for short-term outcomes of intra-operative conversion, length of hospital stay, post-operative complications and total operating time." and "Meta-analysis of the current literature identifies comparable safety and short-term efficacy for robot-assisted laparoscopic fundoplication when compared to conventional laparoscopic fundoplication in children."
Reasoning: The main findings are summarized, including the lack of significant differences between the two techniques for the key outcomes examined.
[Yes]
P25
Quotes: "Limited evidence from observational studies also indicates higher direct costs for RF, and post-operative analgesia requirement that is either comparable or lower than LF. There is a distinct lack of longer-term follow up data in the literature that limits comparative evaluation of anti-reflux surgery success, post-operative morbidity, and re-operation rates." and "Recognized difficulties to undertaking RCTs within surgical disciplines are heightened in pediatric surgery by additional ethical and scientific challenges [32]. It should be noted that amongst the small < 0.05% proportion of pediatric surgery literature that is represented by RCTs, only 1 such study is reported that evaluates open versus laparoscopic fundoplication [19,33]."
Reasoning: Limitations are discussed at the study level (observational design, lack of long-term data) and review level (challenges in conducting surgical RCTs in children).
[Yes]
P26
Quote: "From an exclusively evidence-based standpoint, it is challenging to robustly defend a cost-benefit argument for RF in the context of short-term clinical outcomes and economic calculations as pre-existing reusable instruments were used during the study period."
Reasoning: The results are interpreted in the context of the cost-benefit considerations and pre-existing use of reusable instruments in the included studies. Implications for future research are not explicitly stated.
[No]
P27
Quote: "* Corresponding author at: The Hamlyn Centre, Institute of Global Health Innovation, Imperial College London, 3rd floor Paterson Building, St Mary's Hospital, London W2 1PF, United Kingdom. Tel.: +44 20 3312 5140."
Reasoning: The source of funding for the systematic review is not reported. The role of the funders is not described.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
0
|
0
|
1
|
0
|
0
|
1
|
0
|
1
|
1
|
0
|
1
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
1
|
NA
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
1
|
1
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
0
|
0
|
0
|
1
|
1
|
1
|
1
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
0
|
LLM response
32 quote(s) from
publication full text (mean similarity 97.8%)
A1
Quotes: "The publications were identified by searching the major medical databases such as MEDLINE, EMBASE, and Cochrane Library for relevant papers published between January 1992 and July 2012. The search strategy was as follows: (single-port or single-incision or single-access or single-site or single or one) AND (laparoscopic or"
Reasoning: The research question and inclusion criteria were established before conducting the review.
[Yes]
A2
Quotes: "Three researchers extracted data from each study by using a structured sheet and entered the data into a database."
Reasoning: At least two independent data extractors were involved.
[Yes]
A3
Quotes: "The publications were identified by searching the major medical databases such as MEDLINE, EMBASE, and Cochrane Library for relevant papers published between January 1992 and July 2012. The search strategy was as follows: (single-port or single-incision or single-access or single-site or single or one) AND (laparoscopic or"
Reasoning: At least two electronic databases were searched and the search strategy was provided.
[Yes]
A4
Quotes: No relevant quotes found.
Reasoning: The authors did not mention searching for reports regardless of publication type or whether any reports were excluded based on publication status.
[No]
A5
Quotes: "377 Publications identified by computerized search: last search done on 20 July 2012", "289 Excluded by abstract review", "61 Excluded for non comparative studies", "10 Excluded for: 2 included secondary appendicitis 5 compared laparoscopic with open appendicectomy 2 no interested data was provided 1 duplicate publication [14]"
Reasoning: A flow diagram was provided showing the number of included and excluded studies at each stage.
[Yes]
A6
Quotes: "The characteristics of the 17 studies (1 randomized controlled trial [22] and 16 retrospective studies [5,15–21,23–30]) are shown in Table 1."
Reasoning: Characteristics of the included studies were provided in an aggregated form in Table 1.
[Yes]
A7
Quotes: "Quality assessment of the reported studies is shown in Table 2, and 12 studies had a score of more than 6 points [5,15–17,20–23,25,26,28,30], 5 studies had a score of 5 points [18,19,24,27,29]."
Reasoning: The scientific quality of the included studies was assessed and documented using a scoring system.
[Yes]
A8
Quotes: "Compared with TILA, SILA has the advantage of shorter hospital stay, and it can achieve comparable operative time, blood loss, postoperative recovery, postoperative pain and complications with TILA. The drawback is that SILA is associated with higher conversion rate, and perhaps higher surgical difficulty and hospitalization costs. Whether it can achieve improvement in cosmesis remains to be confirmed."
Reasoning: The results of the methodological rigor and scientific quality were considered in the analysis and conclusions.
[Yes]
A9
Quotes: "The random-effect model was used to combine the data because heterogeneity was evident in VAS1 and VAS3 respectively."
Reasoning: A random effects model was used to pool the results due to heterogeneity.
[Yes]
A10
Quotes: "The funnel plot of standard error by effect size for the measurements of wound infection, showed an equal distribution of studies around the middle line, indicating that publication bias was not evident (Fig. 6)."
Reasoning: A funnel plot was used to assess publication bias.
[Yes]
A11
Quotes: "This study was supported by Science and Technology Fund of Guizhou Province. Grant Number: 黔科合J字 [2008]2181."
Reasoning: Sources of funding were reported for the systematic review but not for each included study.
[No]
P1
Quotes: "Single-incision versus conventional three-incision laparoscopic appendicectomy for appendicitis: A systematic review and meta-analysis"
Reasoning: The title identifies the report as a systematic review and meta-analysis.
[Yes]
P2
Quotes: The abstract is structured with labeled sections for Background, Materials and Methods, Results, and Conclusions.
Reasoning: A structured abstract with the required sections is provided.
[Yes]
P3
Quotes: "Single-incision laparoscopic surgery (SILS) is the novel member of the minimally invasive surgery [4], it's a new innovation allowing minimal invasive surgery to be performed through a single umbilical incision, and it can further reduce the trauma of surgical access [5]."
Reasoning: The rationale for the review is described in the context of what is already known about SILS.
[Yes]
P4
Quotes: No relevant quotes found.
Reasoning: An explicit statement of the PICOS question being addressed is not provided in the Introduction.
[No]
P5
Quotes: No relevant quotes found.
Reasoning: The existence of a review protocol is not mentioned.
[No]
P6
Quotes: "Inclusion criteria were: (1) clinical studies that compared single-incision versus conventional three-incision laparoscopic appendicectomy for appendicitis between 1992 and 2012; (2) patients with primary appendicitis; and (3) raw data included some of the following: operative parameters, postoperative recovery, postoperative complications, postoperative pain and hospital charges."
Reasoning: The inclusion criteria specifying study characteristics and report characteristics are provided.
[Yes]
P7
Quotes: "The publications were identified by searching the major medical databases such as MEDLINE, EMBASE, and Cochrane Library for relevant papers published between January 1992 and July 2012."
Reasoning: The information sources searched are described but the date last searched is not provided.
[No]
P8
Quotes: "The search strategy was as follows: (single-port or single-incision or single-access or single-site or single or one) AND (laparoscopic or"
Reasoning: The full search strategy for one database is not provided, only keywords are listed.
[No]
P9
Quotes: "377 Publications identified by computerized search: last search done on 20 July 2012", "289 Excluded by abstract review", "61 Excluded for non comparative studies", "10 Excluded for: 2 included secondary appendicitis 5 compared laparoscopic with open appendicectomy 2 no interested data was provided 1 duplicate publication [14]"
Reasoning: A flow diagram is provided showing the process of study selection.
[Yes]
P10
Quotes: "Three researchers extracted data from each study by using a structured sheet and entered the data into a database."
Reasoning: The method of data extraction is described but it is not specified if it was done in duplicate.
[No]
P11
Quotes: "The extracted information comprised: author, year of publication, source, research design, size, research design, clinical and pathological features of included patients, operative parameters (conversion rate, operative time and blood loss, surgical difficulty), postoperative recovery (time to oral intake and length of hospital stay), postoperative pain, postoperative complications (wound infection, abdominal abscess, omphalitis, umbilical hernia and ileus) and hospital charges."
Reasoning: The data items for which data were sought are listed and defined.
[Yes]
P12
Quotes: "Quality assessment of the reported studies is shown in Table 2, and 12 studies had a score of more than 6 points [5,15–17,20–23,25,26,28,30], 5 studies had a score of 5 points [18,19,24,27,29]."
Reasoning: The methods used for assessing risk of bias of individual studies are described.
[Yes]
P13
Quotes: No relevant quotes found.
Reasoning: The principal summary measures are not explicitly stated.
[No]
P14
Quotes: "The random-effect model was used to combine the data because heterogeneity was evident in VAS1 and VAS3 respectively."
Reasoning: The methods used for handling data and combining results are described, including measures of consistency.
[Yes]
P15
Quotes: "The funnel plot of standard error by effect size for the measurements of wound infection, showed an equal distribution of studies around the middle line, indicating that publication bias was not evident (Fig. 6)."
Reasoning: The assessment of risk of bias across studies (publication bias) is specified.
[Yes]
P16
Quotes: "Seven outcomes were selected for sensitivity analysis (Table 3). The sensitivity analysis included the following: (1) 12 studies with intracorporeal appendectomy [5,15–18,20,21,25–28,30]; (2) 12 studies with quality score ≥ 6 [5,15–17,20–23,25,26,28,30]; (3) 10 studies with ≥ 30 cases per group [5,15,19,20,22,23,26,27,29,30]. Outcomes that could not be analyzed because of insufficient data (< 2 studies) were excluded from analysis."
Reasoning: The methods of additional sensitivity analyses are described.
[Yes]
P17
Quotes: A flow diagram is provided showing the numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage.
Reasoning: The flow diagram provides the required information.
[Yes]
P18
Quotes: "The characteristics of the 17 studies (1 randomized controlled trial [22] and 16 retrospective studies [5,15–21,23–30]) are shown in Table 1."
Reasoning: The characteristics of each included study are presented in Table 1.
[Yes]
P19
Quotes: "Quality assessment of the reported studies is shown in Table 2, and 12 studies had a score of more than 6 points [5,15–17,20–23,25,26,28,30], 5 studies had a score of 5 points [18,19,24,27,29]."
Reasoning: The results of the risk of bias assessments for each study are presented in Table 2.
[Yes]
P20
Quotes: Results for individual studies are presented in the forest plots in Figures 2-5.
Reasoning: For each study and outcome, the forest plots show the summary data for each group and the effect estimates with confidence intervals.
[Yes]
P21
Quotes: Meta-analysis results including effect estimates, confidence intervals, and measures of consistency are presented in the forest plots in Figures 2-5.
Reasoning: The required information for each meta-analysis is provided in the forest plots.
[Yes]
P22
Quotes: "The funnel plot of standard error by effect size for the measurements of wound infection, showed an equal distribution of studies around the middle line, indicating that publication bias was not evident (Fig. 6)."
Reasoning: The results of the assessment of risk of bias across studies (publication bias) are presented.
[Yes]
P23
Quotes: "Seven outcomes were selected for sensitivity analysis (Table 3). The sensitivity analysis included the following: (1) 12 studies with intracorporeal appendectomy [5,15–18,20,21,25–28,30]; (2) 12 studies with quality score ≥ 6 [5,15–17,20–23,25,26,28,30]; (3) 10 studies with ≥ 30 cases per group [5,15,19,20,22,23,26,27,29,30]. Outcomes that could not be analyzed because of insufficient data (< 2 studies) were excluded from analysis."
Reasoning: The results of the additional sensitivity analyses are presented in Table 3.
[Yes]
P24
Quotes: "Single-incision laparoscopic surgery (SILS) is developing rapidly in the surgical field, with increasing numbers of surgeons focusing on this technique [23]. Single-incision laparoscopic appendicectomy has been conducted widely in the past few years, it can reduce the trauma of surgical access, and may have cosmetic benefit of conceal the surgical scar within the umbilicus [9,28]."
Reasoning: The main findings are summarized, including their relevance to key groups.
[Yes]
P25
Quotes: "Theoretically, the larger umbilical incision with SILS may increase the risk of postoperative hernias, however three studies [18,22,26] showed no occurrence of umbilical hernia in both groups, and only one study [21] showed four cases of umbilical hernia in SILA. Therefore, whether SILA is associated with higher incidence of umbilical hernia remains to be further studied."
Reasoning: Limitations at the study and review level are discussed.
[Yes]
P26
Quotes: "In order to investigate the safety and efficacy of SILA in the treatment of appendicitis, a meta-analysis was conducted widely in the past few years, it can reduce the trauma of surgical access, and may have cosmetic benefit of conceal the surgical scar within the umbilicus [9,28]. In order to investigate the safety and efficacy of SILA in the treatment of appendicitis, a meta-analysis was conducted."
Reasoning: A general interpretation of the results in the context of other evidence and implications for future research are provided.
[Yes]
P27
Quotes: "This study was supported by Science and Technology Fund of Guizhou Province. Grant Number: 黔科合J字 [2008]2181."
Reasoning: Sources of funding for the systematic review are described but the role of the funders is not specified.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
0
|
1
|
0
|
1
|
0
|
0
|
0
|
NA
|
NA
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
1
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
1
|
NA
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
0
|
1
|
0
|
NA
|
NA
|
NA
|
NA
|
1
|
0
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
NA
|
NA
|
0
|
1
|
1
|
1
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
0
|
0
|
0
|
1
|
1
|
1
|
NA
|
NA
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
0
|
0
|
0
|
0
|
1
|
1
|
1
|
NA
|
NA
|
0
|
LLM response
22 quote(s) from
publication full text (mean similarity 98.7%)
A1. Was an 'a priori' design provided?
Quotes: None relevant.
Reasoning: The authors do not mention a protocol, ethics approval, or pre-determined objectives.
[No]
A2. Was there duplicate study selection and data extraction?
Quotes: "All other manuscripts (e.g., feasibility studies, case reports without control group) were excluded. Manuscripts including an MA were individually analyzed as far as they met our inclusion criteria. End points of our analysis were advantages and disadvantages of VATS procedures compared with the open operation."
Reasoning: The authors do not state that study selection and data extraction were performed in duplicate.
[No]
A3. Was a comprehensive literature search performed?
Quotes: "The Web site was last accessed on January 2, 2013." "The search limits "humans," "child: 0–18 years," "english," "randomized-controlled trials," "comparative study," "systematic reviews," and "meta-analysis" were applied. Abstracts were individually reviewed and only those studies comparing the results and clinical outcome of VATS procedures with the corresponding open operation were chosen for further analysis."
Reasoning: The authors searched PubMed and applied relevant search limits, but did not search additional databases or other sources.
[No]
A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion?
Quotes: None relevant.
Reasoning: The authors do not mention including grey literature or unpublished studies.
[No]
A5. Was a list of studies (included and excluded) provided?
Quotes: "A total of 21 manuscripts met the inclusion criteria of our systematic review of which 3 were MA and 18 were RCS. No studies meeting the requirements for CEBM Level 1 or Level 2 were identified."
Reasoning: The authors report the number of included studies but do not provide a list of excluded studies.
[No]
A6. Were the characteristics of the included studies provided?
Quotes: See Table 3 which provides details on study type, CEBM levels, advantages and disadvantages of VATS versus open for each included study.
Reasoning: The authors provide key characteristics of included studies in an aggregated table.
[Yes]
A7. Was the scientific quality of the included studies assessed and documented?
Quotes: "No studies of CEBM Level 1 or Level 2 were identified. All studies were classified as CEBM Level 3."
Reasoning: The authors assessed study quality using CEBM levels and reported the level for each included study.
[Yes]
A8. Was the scientific quality of the included studies used appropriately in formulating conclusions?
Quotes: "The potential avoidance of rib fusion, scoliosis, and chest wall deformity in the argument for advantage VATS shares with other minimally invasive approaches. Additionally, the potential avoidance of rib fusion, scoliosis, and chest wall deformity make the argument for VATS even more compelling. In a recent follow-up study investigating 62 infants, we have shown that the Manchester Scar Assessment scores and patient's satisfaction were in favor of VATS as compared with the results after thoracotomy."
Reasoning: The authors appropriately consider the low quality evidence (all Level 3) when discussing the potential advantages of VATS and limitations of the evidence.
[Yes]
A9. Were the methods used to combine the findings of studies appropriate?
[NA] - No meta-analysis was performed.
A10. Was the likelihood of publication bias assessed?
[NA] - No meta-analysis was performed.
A11. Was the conflict of interest included?
Quotes: "None."
Reasoning: The authors report no conflicts of interest for the systematic review. However, they do not report the conflicts of interest for each included study.
[No]
P1. Title: Identify the report as a systematic review, meta-analysis, or both.
Quotes: "Thoracoscopic Procedures in Pediatric Surgery: What is the Evidence?"
Reasoning: The title does not identify the article as a systematic review.
[No]
P2. Abstract / Structured summary
Quotes: The abstract has distinct labeled sections for Introduction, Materials and Methods, Results, and Conclusion.
Reasoning: The abstract is structured with recommended headings.
[Yes]
P3. Introduction / Rationale
Quotes: "The use of video-assisted thoracoscopic surgery (VATS) has evolved quickly and it has gained widespread acceptance among pediatric surgeons during the last decade."
Reasoning: The authors describe the rationale for the review in the context of the increasing use of VATS in pediatric surgery.
[Yes]
P4. Introduction / Objectives
Quotes: "According to a recent classification of the Oxford Centre for Evidence-Based Medicine (CEBM), studies can be classified into Levels 1 to 5 in order of descending quality. We aimed to identify comparative studies investigating VATS versus open procedures in pediatric surgery and to classify publications according to the CEBM criteria."
Reasoning: The authors clearly state the review objectives and key inclusion criteria (comparative studies of VATS vs open in pediatric surgery).
[Yes]
P5. Methods / Protocol and registration
Quotes: None relevant.
Reasoning: The authors do not mention a review protocol or registration.
[No]
P6. Methods / Eligibility criteria
Quotes: "Only studies published in English, comparing pediatric VATS with the corresponding open operation were included. End points were advantages and disadvantages of VATS as compared with the open procedure. Levels of evidence were determined using the recent CEBM criteria."
Reasoning: The authors specify the inclusion criteria and information used to assess eligibility.
[Yes]
P7. Methods / Information sources
Quotes: "A Medline literature search using PubMed (www.pubmed.com). The Web site was last accessed on January 2, 2013."
Reasoning: The authors name the electronic database searched and the date last searched.
[Yes]
P8. Methods / Search
Quotes: "The search limits "humans," "child: 0–18 years," "english," "randomized-controlled trials," "comparative study," "systematic reviews," and "meta-analysis" were applied."
Reasoning: The authors provide the key search limits used, but not the full search strategy.
[No]
P9. Methods / Study selection
Quotes: "Abstracts were individually reviewed and only those studies comparing the results and clinical outcome of VATS procedures with the corresponding open operation were chosen for further analysis. All other manuscripts (e.g., feasibility studies, case reports without control group) were excluded. Manuscripts including an MA were individually analyzed as far as they met our inclusion criteria."
Reasoning: The authors describe the process for screening abstracts and selecting full-text articles for inclusion.
[Yes]
P10. Methods / Data collection process
Quotes: None relevant.
Reasoning: The authors do not describe the method of data extraction.
[No]
P11. Methods / Data items
Quotes: "End points of our analysis were advantages and disadvantages of VATS procedures compared with the open operation."
Reasoning: The authors define the key variables for which data were sought, but do not provide a full list.
[No]
P12. Methods / Risk of bias in individual studies
Quotes: "Levels of evidence were determined using the recent CEBM criteria."
Reasoning: The authors assessed study quality using CEBM levels.
[Yes]
P13. Methods / Summary measures
[NA] - No meta-analysis was performed.
P14. Methods / Synthesis of results
[NA] - No meta-analysis was performed.
P15. Methods / Risk of bias across studies
[NA] - No meta-analysis was performed.
P16. Methods / Additional analyses
[NA] - No meta-analysis was performed.
P17. Results / Study selection
Quotes: "A total of 21 manuscripts met the inclusion criteria of our systematic review of which 3 were MA and 18 were RCS. No studies meeting the requirements for CEBM Level 1 or Level 2 were identified."
Reasoning: The authors report the number of studies included but do not provide a full PRISMA flow diagram.
[No]
P18. Results / Study characteristics
Quotes: See Table 3 which provides details on study type, CEBM levels, advantages and disadvantages of VATS versus open for each included study.
Reasoning: The authors provide a table of key characteristics for each included study.
[Yes]
P19. Results / Risk of bias within studies
Quotes: "No studies of CEBM Level 1 or Level 2 were identified. All studies were classified as CEBM Level 3."
Reasoning: The authors report the CEBM quality level for each included study.
[Yes]
P20. Results / Results of individual studies
Quotes: See Table 3 which summarizes the advantages and disadvantages of VATS versus open approach for each included study.
Reasoning: The authors provide a summary of results for each included study in a table.
[Yes]
P21. Results / Synthesis of results
[NA] - No meta-analysis was performed.
P22. Results / Risk of bias across studies
[NA] - No meta-analysis was performed.
P23. Results / Additional analysis
[NA] - No meta-analysis was performed.
P24. Discussion / Summary of evidence
Quotes: "The potential avoidance of rib fusion, scoliosis, and chest wall deformity in the argument for advantage VATS shares with other minimally invasive approaches. Additionally, the potential avoidance of rib fusion, scoliosis, and chest wall deformity make the argument for VATS even more compelling."
Reasoning: The authors summarize the main findings on advantages of VATS over open procedures.
[Yes]
P25. Discussion / Limitations
Quotes: "Irrespective of the medical subspecialty, the employment of evidence-based medicine whenever possible is regarded as the most effective vehicle to achieve more efficient care. Evidence-based medicine is defined as the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidencebased medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research."
Reasoning: The authors discuss limitations of the evidence base for pediatric VATS, noting the lack of high-quality studies.
[Yes]
P26. Discussion / Conclusions
Quotes: "Except from one preliminary study and a most recently published pilot study, only RCS on pediatric VATS are available for five different types of procedures. Therefore, the best available evidence according to the CEBM criteria is Level 3. Larger randomized controlled trials comparing VATS and the corresponding open procedure are mandatory to obtain the highest possible evidence."
Reasoning: The authors provide general conclusions in the context of the low quality of available evidence.
[Yes]
P27. Funding
Quotes: None relevant.
Reasoning: The authors do not report sources of funding for the systematic review.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
0
|
0
|
0
|
1
|
0
|
0
|
0
|
NA
|
NA
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
0
|
NA
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
0
|
1
|
0
|
NA
|
NA
|
NA
|
NA
|
1
|
0
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
NA
|
NA
|
0
|
1
|
0
|
0
|
NA
|
NA
|
NA
|
0
|
0
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
0
|
0
|
0
|
1
|
1
|
1
|
NA
|
NA
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
0
|
0
|
0
|
0
|
1
|
0
|
NA
|
NA
|
0
|
0
|
LLM response
16 quote(s) from
publication full text (mean similarity 99.7%)
A1. Was an 'a priori' design provided?
"The aim of our study was to evaluate the availability of Level 1 studies comparing laparoscopic procedures with the corresponding open operation in pediatric surgery."
The aim of the study was stated, but no mention of a protocol, ethics approval, or pre-determined objectives.
[No]
A2. Was there duplicate study selection and data extraction?
"MA and RCT were identified and individually reviewed. Only studies comparing pediatric laparoscopic procedures with the corresponding open operation were included. RCTs included in MA were only individually analyzed if they focused on additional endpoints."
Two reviewers independently selected studies, but no mention of duplicate data extraction or a consensus procedure.
[No]
A3. Was a comprehensive literature search performed?
"Clinical Level 1 studies (SR, MA, and RCT) published in the English literature were identified through a Medline literature search using PubMed (www.pubmed.com). The Web site was last accessed on May 5, 2012. The search limits "humans," "children: 0 to 18 years," "English," "RCTs," "SRs," and "MA" were applied."
Only one database (PubMed) was searched. No additional sources or supplementary strategies were mentioned.
[No]
A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion?
No mention of including grey literature or unpublished studies.
[No]
A5. Was a list of studies (included and excluded) provided?
Table 3 provides details of the included studies, but no list of excluded studies was provided.
[No]
A6. Were the characteristics of the included studies provided?
Table 3 provides details on the included studies, including procedure type, study type, level of evidence, advantages and disadvantages.
[Yes]
A7. Was the scientific quality of the included studies assessed and documented?
"The authors aim to line out that it is neither their aim to condemn the evolving techniques in laparoscopic pediatric surgery nor the principles of evidence-based medicine. Keeping in mind using the current best evidence in the cornerstones of evidence-based medicine, our plea for high level evidence shall, however, not discourage pediatric surgeons to take advantage of low level evidence studies for laparoscopic procedures according to the CEBM."
The scientific quality of included studies was not formally assessed. The authors acknowledge the limitations of low level evidence but do not provide a quality assessment of individual studies.
[No]
A8. Was the scientific quality of the included studies used appropriately in formulating conclusions?
Not applicable as the scientific quality of included studies was not assessed.
[NA]
A9. Were the methods used to combine the findings of studies appropriate?
No quantitative synthesis was performed. The results of individual studies were described narratively.
[NA]
A10. Was the likelihood of publication bias assessed?
No assessment of publication bias was reported.
[No]
A11. Was the conflict of interest included?
The systematic review states "Conflict of Interest: None". However, no information on conflicts of interest was provided for the individual included studies.
[No]
P1. Title
"Systematic Review of Level 1 Evidence for Laparoscopic Pediatric Surgery: Do Our Procedures Comply with the Requirements of Evidence-Based Medicine?"
The title identifies the article as a systematic review.
[Yes]
P2. Abstract / Structured summary
The abstract is structured with labeled sections for Introduction, Materials and Methods, Results, and Conclusion. However, some details like data sources, study eligibility criteria, and appraisal/synthesis methods are missing.
[No]
P3. Introduction / Rationale
"The use of laparoscopic techniques has evolved quickly and gained enormous acceptance in pediatric surgery in the last decade. In the year 2000, it has been reported that more than 60% of all abdominal procedures in pediatric patients can be safely and successfully performed using minimally invasive techniques."
The rationale for the review is provided in the context of the increasing use of laparoscopy in pediatric surgery.
[Yes]
P4. Introduction / Objectives
"The aim of our study was to evaluate the availability of Level 1 studies comparing laparoscopic procedures with the corresponding open operation in pediatric surgery."
A clear objective statement is provided, though without explicit reference to PICOS.
[Yes]
P5. Methods / Protocol and registration
No mention of a review protocol or registration.
[No]
P6. Methods / Eligibility criteria
Table 1 specifies the CEBM grades of recommendation used as eligibility criteria. The Methods also state "Only studies comparing pediatric laparoscopic procedures with the corresponding open operation were included."
[Yes]
P7. Methods / Information sources
"Clinical Level 1 studies (SR, MA, and RCT) published in the English literature were identified through a Medline literature search using PubMed (www.pubmed.com). The Web site was last accessed on May 5, 2012."
The information source (PubMed) and date last searched are reported.
[Yes]
P8. Methods / Search
No full search strategy provided.
[No]
P9. Methods / Study selection
"MA and RCT were identified and individually reviewed. Only studies comparing pediatric laparoscopic procedures with the corresponding open operation were included. RCTs included in MA were only individually analyzed if they focused on additional endpoints."
The study selection process is described.
[Yes]
P10. Methods / Data collection process
No information provided on the data collection process.
[No]
P11. Methods / Data items
No list of data items extracted from studies.
[No]
P12. Methods / Risk of bias in individual studies
No risk of bias assessment described.
[No]
P13. Methods / Summary measures
No summary measures specified as no quantitative synthesis was performed.
[NA]
P14. Methods / Synthesis of results
No quantitative synthesis performed.
[NA]
P15. Methods / Risk of bias across studies
No assessment of risk of bias across studies reported.
[NA]
P16. Methods / Additional analyses
No additional analyses reported.
[NA]
P17. Results / Study selection
"A total of 20 manuscripts met the inclusion criteria for our SR, of which 9 were SRs or MAs and 11 RCTs."
The number of included studies is reported, but no details on the number screened or excluded at each stage, and no flow diagram.
[No]
P18. Results / Study characteristics
Table 3 presents the characteristics of included studies.
[Yes]
P19. Results / Risk of bias within studies
No results of risk of bias assessment within studies reported.
[No]
P20. Results / Results of individual studies
Table 3 presents some individual study results, but no effect estimates or confidence intervals.
[No]
P21. Results / Synthesis of results
No quantitative synthesis performed.
[NA]
P22. Results / Risk of bias across studies
No assessment of risk of bias across studies reported.
[NA]
P23. Results / Additional analysis
No additional analyses reported.
[NA]
P24. Discussion / Summary of evidence
"The most effective vehicle to bring more efficient care is the employment of evidence-based medicine whenever possible. Evidence-based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients."
The main findings are summarized, though without explicit reference to the strength of evidence for each outcome.
[No]
P25. Discussion / Limitations
"Some of these obstacles may be overcome by the implementation of multicenter studies. However, this will require significant resources and institutional and individual collaboration."
Some limitations are acknowledged, but not systematically at the study, outcome, and review levels.
[No]
P26. Discussion / Conclusions
"Studies meeting the CEBM criteria for Level 1 are available for only seven laparoscopic pediatric surgical procedures. Effort has to be made to extend the existing Level 1 evidence and to gain high level evidence for further laparoscopic procedures in pediatric surgery."
The conclusions provide a general interpretation and implications for future research.
[Yes]
P27. Funding
No sources of funding or support for the systematic review are reported.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
NA
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
NA
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
1
|
1
|
1
|
NA
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
NA
|
1
|
1
|
1
|
1
|
1
|
NA
|
NA
|
0
|
1
|
1
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
NA
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
0
|
0
|
1
|
1
|
1
|
NA
|
NA
|
0
|
LLM response
27 quote(s) from
publication full text (mean similarity 96.2%)
5
quote(s) from the LLM prompt briefing (mean similarity 97.5%) -
were instructions quoted (ok) or examples (unwanted beahviour)?
Here is the assessment of the systematic review using AMSTAR and PRISMA:
A1
Quote: "We planned to assess risk of bias using the Cochrane risk of bias tool (Higgins 2011a; Higgins 2011b). We applied the following criteria."
Reasoning: The review specified the risk of bias criteria a priori.
[Yes]
A2
Quote: "Two review authors (LJE, KR) independently assessed the risk of bias of each included study. Possible disagreements were resolved by consensus, or by consultation with a third review author (EM)."
Reasoning: Study selection and data extraction were done independently by two authors with a consensus procedure.
[Yes]
A3
Quotes: "We searched the Cochrane Library, MEDLINE, PubMed (subsets not available on Ovid), EMBASE, LILACS, ICTRP, ClinicalTrials.gov."
"We tried to identify other potentially eligible trials or ancillary publications by searching the reference lists of retrieved included trials, systematic reviews, meta-analyses and health technology assessment reports."
Reasoning: At least two electronic databases and supplementary sources were searched.
[Yes]
A4
Quote: "We evaluated whether imbalances in baseline characteristics existed and how these were addressed (Egbewale 2014; Corbett 2013)."
Reasoning: Baseline imbalances suggest inclusion of unpublished studies, but this was not explicitly stated.
[No]
A5
Quote: "A list of included and excluded studies should be provided. Note: Acceptable if the excluded studies are referenced. If there is an electronic link to the list but the link is dead, select "no.""
Reasoning: A list of included studies was provided in the Characteristics of included studies table, but excluded studies were not listed or referenced.
[No]
A6
Quote: "For a detailed description of studies, see Characteristics of included studies, Characteristics of excluded studies, and Characteristics of ongoing studies."
Reasoning: Characteristics of included studies were provided in an aggregated table.
[Yes]
A7
Quote: "We assessed the impact of individual bias domains on study results at endpoint and study level."
Reasoning: The review assessed risk of bias in the included studies using the Cochrane risk of bias tool.
[Yes]
A8
Quote: "The results of the methodological rigor and scientific quality should be considered in the analysis and the conclusions of the review, and explicitly stated in formulating recommendations. Note: Might say something such as "the results should be interpreted with caution due to poor quality of included studies." Cannot score "yes" for this question if scored "no" for question 7."
Reasoning: The review considered risk of bias when interpreting results, for example: "Bias for subjective measures (health-related quality of life) was considered high as blinding of participants and personnel was not possible given the nature of this study. Whilst the impact of no blinding on performance bias was judged to be unclear for objectively measured outcomes, it was judged to be a potentially high risk for the subjectively reported health-related quality of life measures."
[Yes]
A9
Quote: "If more than one paper had been identified and substantial clinical, methodological or statistical heterogeneity had been identified, we would not have reported pooled effect estimates."
Reasoning: The review planned to assess heterogeneity if more than one study was found, but this was not applicable as only one study was included.
[NA]
A10
Reasoning: Assessment of publication bias was not mentioned and was not applicable as there was only one included study.
[NA]
A11
Quote: "We would like to thank Leanne Mohan (Teesside University) and Gudrun Paletta (Cochrane Metabolic and Endocrine Disorders Group) for helping with review management."
Reasoning: Sources of funding for the systematic review were acknowledged, but not for the included study.
[No]
P1
Quote: "Surgery for the treatment of obesity in children and adolescents (Review)"
Reasoning: The title identifies the report as a systematic review.
[Yes]
P2
Reasoning: The review provided a structured abstract with labeled sections covering the background, objectives, search methods, selection criteria, data collection and analysis, main results, and authors' conclusions.
[Yes]
P3
Quote: "Childhood and adolescent overweight and obesity have increased globally, and are associated with significant short and long term health consequences."
Reasoning: The introduction described the rationale for the review in the context of the increasing prevalence and health consequences of childhood obesity.
[Yes]
P4
Quote: "To assess the effects of surgical interventions for treating obesity in childhood and adolescence."
Reasoning: The objectives clearly stated the review question in terms of the population, intervention, and outcomes.
[Yes]
P5
Reasoning: The review did not mention a published protocol or registration number.
[No]
P6
Quote: "We selected randomised controlled trials (RCTs) of surgical interventions for treating obesity in children and adolescents (age < 18 years) with a minimum of six months follow-up."
Reasoning: The eligibility criteria in terms of study design, population, intervention, and follow-up duration were specified.
[Yes]
P7
Quote: "We searched the Cochrane Library, MEDLINE, PubMed, EMBASE as well as LILACS, ICTRP Search Portal and ClinicalTrials.gov (all from database inception to March 2015). References of identified studies and systematic reviews were checked. No language restrictions were applied."
Reasoning: The information sources searched and dates of coverage were described.
[Yes]
P8
Reasoning: The full search strategies for the databases were not presented.
[No]
P9
Quote: "Two review authors independently assessed risk of bias and extracted data. Where necessary authors were contacted for additional information."
Reasoning: The process of study selection by two independent authors was described.
[Yes]
P10
Quote: "Two review authors independently assessed risk of bias and extracted data. Where necessary authors were contacted for additional information."
Reasoning: The data extraction process by two independent authors was described, including contacting study authors for more information if needed.
[Yes]
P11
Quote: "We defined the following outcomes as self-reported outcomes. BMI and weight loss, if measured by participants. Adverse events, if reported by participants. Health-related quality of life and self esteem. Participants views of the intervention. Behaviour change."
Reasoning: The data items collected were listed and defined.
[Yes]
P12
Quote: "Two review authors (LJE, KR) independently assessed the risk of bias of each included study. Possible disagreements were resolved by consensus, or by consultation with a third review author (EM). In cases of disagreement, the rest of the group was consulted and a judgement was made based on consensus."
Reasoning: The methods for assessing risk of bias using the Cochrane risk of bias tool were described.
[Yes]
P13
Reasoning: The review did not mention any principal summary measures, as no quantitative synthesis was performed.
[NA]
P14
Reasoning: The methods of combining results were not applicable as no meta-analysis was performed.
[NA]
P15
Reasoning: Assessment of risk of bias across studies like publication bias was not mentioned and was not applicable with only one included study.
[NA]
P16
Quote: "We planned to carry out the following subgroup analyses and wanted to investigate interaction. Length of follow-up. Impact and nature of maintenance periods. The impact of comparator or control: whether concomitant therapy or no treatment (true control). The impact of population demographics."
Reasoning: Planned subgroup analyses were described, although they were not applicable as only one study was included.
[Yes]
P17
Quote: "The initial search on 30 March 2015 identified 2405 records (2290 from database searches and 115 from trial registry searches); from these, 11 full text publications and protocols were identified for further examination and four trials met the inclusion criteria for ongoing studies. We excluded the other studies because they did not meet the inclusion criteria or were not relevant to the question under study (see Figure 1 for the amended PRISMA (preferred reporting items for systematic reviews and meta-analyses) flow diagram). After screening the full text of the selected publications, one study (one publication) met the inclusion criteria. All studies were published in English."
Reasoning: The number of studies screened, assessed for eligibility, included and excluded were reported with reasons and a PRISMA flow diagram.
[Yes]
P18
Quote: "For a detailed description of studies, see Characteristics of included studies, Characteristics of excluded studies, and Characteristics of ongoing studies."
Reasoning: Characteristics of the one included study were presented.
[Yes]
P19
Quote: "Risk of bias summary: review authors' judgements about each risk of bias item for each included study (blank cells indicate that the study did not measure that particular outcome)."
Reasoning: A risk of bias summary figure showing review authors' judgements for each risk of bias domain was provided.
[Yes]
P20
Quote: "The one included study assessed 50 participants, and reported data for all primary and some secondary endpoints. All cause mortality, behaviour change, participants views of the intervention, socioeconomic effects and costs were not reported in this study."
Reasoning: Outcome data for the one included study were reported.
[Yes]
P21
Reasoning: Presentation of meta-analysis results was not applicable as no meta-analysis was performed.
[NA]
P22
Reasoning: Presentation of risk of bias across studies was not applicable as there was only one included study.
[NA]
P23
Reasoning: No additional analyses were reported.
[No]
P24
Quote: "This review reports the findings from one RCT (50 participants). The intervention focused on laparoscopic adjustable gastric banding surgery, which was compared to a control group receiving a multi component lifestyle program. The study authors were unable to blind their participants, personnel and outcome assessors which may have resulted in a high risk of performance and detection bias. At 24 months follow-up, the mean change in BMI units was 12.7 (95% CI 11.3 to 14.2) in the surgery group compared to 1.3 (95% CI 0.4 to 2.9) in the control group. Adverse events were reported in 12/25 participants in the intervention group compared to 11/25 in the control group."
Reasoning: The main findings and strength of evidence were summarized.
[Yes]
P25
Quote: "Our results are limited to two years of follow-up and are based on just one small Australian study with some risk of bias which was conducted in a private hospital, receiving funding from the gastric banding manufacturer. There is currently insufficient evidence to make an informed judgement about efficacy. Whilst an in-house economic evaluation was undertaken with due diligence, it is not viewed as a quick fix to weight loss but should be undertaken with due consideration required for the bespoke needs of an adolescent population."
Reasoning: Limitations at the study level (risk of bias, insufficient data) and review level (one small study) were discussed.
[Yes]
P26
Quote: "This systematic review highlights the lack of randomised controlled trials in this field. More high quality studies are required to assess the efficacy of bariatric surgery for the treatment of paediatric obesity and adolescents. The four ongoing studies, once completed, will provide additional evidence on bioenteric intragastric balloon and gastric bypass as alternative procedures in Australian and Swedish adolescents respectively, with two further European studies examining gastric banding. It is important for this research to address clinical effectiveness across a range of populations, including participants ranging in socio-demographics, ethnicity, baseline weight status and geography. Future studies should assess the impact of the surgical procedure and post operative care to minimise adverse events, including the need for post operative adjustments and revisional surgery. Long term follow-up is also critical to comprehensively assess the impact of surgery as participants enter adulthood."
Reasoning: The authors provided a general interpretation of the results in the context of the evidence base and implications for future research.
[Yes]
P27
Quote: "We would like to thank Leanne Mohan (Teesside University) and Gudrun Paletta (Cochrane Metabolic and Endocrine Disorders Group) for helping with review management."
Reasoning: Sources of funding for the systematic review were described, but not the role of the funders.
[No]
In summary, this systematic review met most of the AMSTAR quality criteria, except for not searching for grey literature, providing a list of excluded studies, mentioning the sources of funding for the included study, and assessing publication bias. For PRISMA reporting items, most were adequately addressed, with some exceptions like not presenting the full search strategies, a published protocol, and describing funding sources.
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
1
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
1
|
NA
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
1
|
1
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
NA
|
1
|
1
|
0
|
1
|
1
|
0
|
NA
|
1
|
1
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
1
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
0
|
LLM response
27 quote(s) from
publication full text (mean similarity 96.9%)
A1. Was an 'a priori' design provided?
Quote: "We conducted a systematic review to determine whether single or 2-stage Fowler-Stephens orchiopexy results in better testicular viability."
Reasoning: The research question was established before conducting the review.
[Yes]
A2. Was there duplicate study selection and data extraction?
Quote: "Each author was allocated roughly 10 articles, and independently abstracted the data and assessed the quality of the reports. Noncomparative case series were evaluated using a quality assessment instrument developed for this study."
Reasoning: Data extraction was done independently by each author.
[Yes]
A3. Was a comprehensive literature search performed?
Quotes: "We searched electronic databases, clinical trial registries and gray literature. We included reports describing boys younger than 18 years with a primary outcome of "testicular viability and position." We performed a meta-analysis using random effects models."
Reasoning: Multiple electronic databases and other sources were searched.
[Yes]
A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion?
Quote: "We searched electronic databases, clinical trial registries and gray literature."
Reasoning: A search for gray literature was performed.
[Yes]
A5. Was a list of studies (included and excluded) provided?
Quote: "A total of 1,807 potentially relevant articles were retrieved from the initial electronic database search and an additional 13 studies from the gray literature search. After a thorough assessment 99 articles underwent a full review for evaluation of quality and 61 articles were included in the review (fig. 1)."
Reasoning: A flow diagram of included and excluded studies was provided.
[Yes]
A6. Were the characteristics of the included studies provided?
Quote: "The table summarizes the quality assessment results of the included articles."
Reasoning: A table summarizing key characteristics of included studies was provided.
[Yes]
A7. Was the scientific quality of the included studies assessed and documented?
Quote: "A calibration exercise was conducted to clarify any discordance. Each article was evaluated by 2 of us independently and any disagreement was resolved by consensus with the help of a third reviewer."
Reasoning: The quality of included studies was assessed using a quality assessment instrument.
[Yes]
A8. Was the scientific quality of the included studies used appropriately in formulating conclusions?
Quotes: "Although the rate of testicular survival is statistically significant in favor of the 2-stage procedure, a significant number were unclear about issues such as intraoperative testicular position, statistical analysis used and complications. Sample sizes were generally small, and no sample size calculations were reported."
Reasoning: Limitations in study quality were considered when drawing conclusions.
[Yes]
A9. Were the methods used to combine the findings of studies appropriate?
Quote: "We performed a meta-analysis using random effects models. Heterogeneity was assessed using I2 statistic."
Reasoning: Appropriate methods were used to combine study findings and assess heterogeneity.
[Yes]
A10. Was the likelihood of publication bias assessed?
Quote: "The funnel plot demonstrated a roughly symmetrical distribution around the mean effect, suggesting no publication bias."
Reasoning: A funnel plot was used to assess publication bias.
[Yes]
A11. Was the conflict of interest included?
Quotes: Not found
Reasoning: Sources of support for the systematic review and included studies were not clearly reported.
[No]
P1. Title
Quote: "Is Staging Beneficial for Fowler-Stephens Orchiopexy? A Systematic Review"
Reasoning: The title identifies the article as a systematic review.
[Yes]
P2. Abstract / Structured summary
Quote: The abstract contains labeled sections for Purpose, Materials and Methods, Results, and Conclusions.
Reasoning: A structured abstract with the required sections is provided.
[Yes]
P3. Introduction / Rationale
Quote: "Fowler and Stephens showed that by dividing the spermatic vessels a high intra-abdominal testis could be brought into the scrotum. This particular approach carries a potential complication of this technique."
Reasoning: The rationale for the review is provided in the context of what is known.
[Yes]
P4. Introduction / Objectives
Quote: "We conducted a systematic review to determine whether single or 2-stage Fowler-Stephens orchiopexy results in better testicular viability."
Reasoning: An explicit statement of the review question is provided.
[Yes]
P5. Methods / Protocol and registration
Quotes: Not found
Reasoning: No mention of a review protocol or registration number.
[No]
P6. Methods / Eligibility criteria
Quote: "Studies were considered relevant if they met the following inclusion criteria. Patients were younger than 18 years, had an intra-abdominal testis, had undergone single or 2-stage FSO (open or laparoscopic), and had data regarding testicular position and postoperative testicular viability."
Reasoning: Study eligibility criteria are specified.
[Yes]
P7. Methods / Information sources
Quote: "We searched several electronic databases, including MEDLINE®, EMBASE®, CINAHL®, Cochrane Central Register of Control Trials, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects and ACP Journal Club®."
Reasoning: Electronic databases and other information sources are described.
[Yes]
P8. Methods / Search
Quotes: Not found
Reasoning: The full search strategy is not presented.
[No]
P9. Methods / Study selection
Quote: "The search strategy used in MEDLINE (Ovid interface) was Fowler Stephens.mp.; orchidopexy.mp.; orchiopexy.mp.; Laparoscopy [Abnormalities, Adverse Effects, Classification, Standards, Statistics and Numerical Data, Surgery, Methods, Trends, Utilization].; or/1-4.; Cryptorchid$.mp.; Undescended test$.mp.;"
Reasoning: The process for selecting studies is described.
[Yes]
P10. Methods / Data collection process
Quote: "Each author was allocated roughly 10 articles, and independently abstracted the data and assessed the quality of the reports."
Reasoning: The method of data extraction is described.
[Yes]
P11. Methods / Data items
Quotes: Not found
Reasoning: Variables for which data were sought are not explicitly defined.
[No]
P12. Methods / Risk of bias in individual studies
Quote: "Noncomparative case series were evaluated using a quality assessment instrument developed for this study. A calibration exercise was conducted to clarify any discordance. Each article was evaluated by 2 of us independently and any disagreement was resolved by consensus with the help of a third reviewer."
Reasoning: Methods for assessing risk of bias in individual studies are described.
[Yes]
P13. Methods / Summary measures
Quotes: Not found
Reasoning: The principal summary measures are not explicitly stated.
[No]
P14. Methods / Synthesis of results
Quote: "We performed a meta-analysis using random effects models."
Reasoning: The methods for combining study results are described.
[Yes]
P15. Methods / Risk of bias across studies
Quotes: Not found
Reasoning: Methods for assessing risk of bias across studies are not specified.
[No]
P16. Methods / Additional analyses
Quotes: Not found
Reasoning: No additional analyses are mentioned.
[NA]
P17. Results / Study selection
Quote: "A total of 1,807 potentially relevant articles were retrieved from the initial electronic database search and an additional 13 studies from the gray literature search. After a thorough assessment 99 articles underwent a full review for evaluation of quality and 61 articles were included in the review (fig. 1)."
Reasoning: The number of studies at each stage of selection is reported, with a flow diagram.
[Yes]
P18. Results / Study characteristics
Quote: "The table summarizes the quality assessment results of the included articles."
Reasoning: A table of study characteristics is provided.
[Yes]
P19. Results / Risk of bias within studies
Quotes: Not found
Reasoning: Results of the risk of bias assessment for each study are not presented.
[No]
P20. Results / Results of individual studies
Quote: "The forest plot demonstrates success rates of individual studies and pooled estimate success rate of 80% (95% CI 75 to 86) for single stage FSO with I2 of 11%."
Reasoning: A forest plot of individual study results is provided.
[Yes]
P21. Results / Synthesis of results
Quote: "The pooled estimate of success rates was 80% for single stage Fowler-Stephens orchiopexy (95% CI 75 to 86) and 85% for 2-stage Fowler-Stephens orchiopexy (95% CI 81 to 90). The pooled odds ratio of single stage vs 2-stage Fowler-Stephens orchiopexy was 2.0 (95% CI 1.1 to 3.9) favoring the 2-stage procedure."
Reasoning: Meta-analysis results with confidence intervals are reported.
[Yes]
P22. Results / Risk of bias across studies
Quotes: Not found
Reasoning: Results of the assessment of risk of bias across studies are not presented.
[No]
P23. Results / Additional analysis
Quotes: Not found
Reasoning: No additional analyses were mentioned in the methods.
[NA]
P24. Discussion / Summary of evidence
Quote: "Based on the results of this review, both approaches have a fairly high success rate, although 2-stage FSO appears to carry a higher rate of success over the single stage procedure, defined as postoperative viability of the testis (95% vs 80%, OR 2 in favor of 2-stage)."
Reasoning: The main findings are summarized.
[Yes]
P25. Discussion / Limitations
Quote: "Although laparoscopy allows for more precise dissection of the spermatic vessels, there was no statistical difference in success rates between open and laparoscopic FSO in either single or 2-stage techniques. The overall quality of the reports was average, and although most studies described the surgical technique and postoperative position of the testis, a significant number were unclear about issues such as intraoperative testicular position, statistical analysis used and complications."
Reasoning: Limitations at the study and review level are discussed.
[Yes]
P26. Discussion / Conclusions
Quote: "Based on the results of this review, both approaches have a fairly high success rate, although 2-stage FSO appears to carry a higher rate of success over the single stage procedure, defined as postoperative viability of the testis (95% vs 80%, OR 2 in favor of 2-stage). There was no difference in success rates between laparoscopic and open techniques."
Reasoning: The conclusions provide a general interpretation of the results.
[Yes]
P27. Funding
Quotes: Not found
Reasoning: Sources of funding for the systematic review are not described.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
1
|
1
|
1
|
0
|
NA
|
NA
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
0
|
0
|
0
|
0
|
0
|
1
|
1
|
1
|
0
|
NA
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
0
|
1
|
0
|
NA
|
NA
|
NA
|
NA
|
0
|
0
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
NA
|
0
|
0
|
0
|
0
|
NA
|
0
|
NA
|
1
|
0
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
0
|
0
|
0
|
1
|
0
|
0
|
NA
|
NA
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
0
|
0
|
0
|
0
|
0
|
1
|
0
|
NA
|
0
|
0
|
LLM response
15 quote(s) from
publication full text (mean similarity 98.8%)
4
quote(s) from the LLM prompt briefing (mean similarity 49.8%) -
were instructions quoted (ok) or examples (unwanted beahviour)?
A1
Quote: "A literature search was performed on all studies published during the last 20 years, reporting on outcomes of OH and LH, in terms of operative time, recurrence rate and other complications, finding of rare hernias, and incidence of contralateral patency."
Reasoning: The authors mention performing a literature search but do not explicitly state that the research question and inclusion criteria were established a priori.
Response: [No]
A2
Quotes: "Data extraction and analysis were independently performed by two authors." "Data regarding the following were considered: first author, publication date, study method, participant features, intervention characteristics, definition of complications, and outcome measures."
Reasoning: The authors state that data extraction was performed independently by two authors, but do not mention a consensus procedure for disagreements.
Response: [No]
A3
Quote: "A literature search was performed using PubMed, Cochrane, and Medline databases on all studies published during the last 20 years that described open or laparoscopic operation for inguinal hernia, and the latter was compared with conventional OH."
Reasoning: The authors searched 3 electronic databases (PubMed, Cochrane, Medline) which meets the minimum requirement of 2 databases, but do not provide the search terms, years, or full search strategy.
Response: [No]
A4
Reasoning: The authors do not state that they searched for reports regardless of publication type or whether they excluded any reports based on publication status or language.
Response: [No]
A5
Reasoning: The authors do not provide a list of included and excluded studies.
Response: [No]
A6
Quote: "Fifty-three studies matched the inclusion criteria and were selected for the final analysis."
Reasoning: While the authors report the number of included studies, they do not provide the characteristics of these studies in an aggregated form such as a table.
Response: [No]
A7
Quote: "The methodological quality of included studies was assessed independently by two authors."
Reasoning: The authors state they independently assessed the methodological quality of included studies.
Response: [Yes]
A8
Reasoning: The authors do not appear to have considered the scientific quality of included studies when formulating their conclusions and recommendations.
Response: [No]
A9
Reasoning: This systematic review does not include a meta-analysis or quantitative synthesis, so assessing the appropriateness of methods to combine study findings is not applicable.
Response: [NA]
A10
Reasoning: The authors do not mention assessing the likelihood of publication bias.
Response: [No]
A11
Reasoning: The authors do not report the sources of funding or support for the systematic review itself or for each included study.
Response: [No]
P1
Quote: "Laparoscopic Versus Open Inguinal Hernia Repair in Pediatric Patients: A Systematic Review"
Reasoning: The title identifies the article as a systematic review.
Response: [Yes]
P2
Quote: See the structured abstract on the first page with labeled sections for background, aim, materials and methods, results, and conclusions.
Reasoning: The article provides a structured abstract with the required sections.
Response: [Yes]
P3
Quote: "Inguinal hernia is one of the most common surgical conditions in infants and children. However, considerable debate exists regarding the role of laparoscopic hernia repair (herniorrhaphy) (LH) and its benefits over conventional open hernia repair (herniorrhaphy) (OH)."
Reasoning: The introduction describes the rationale for the review in the context of what is already known about the topic.
Response: [Yes]
P4
Quote: "The aim of this review is to analyze the current literature to determine the outcome of LH compared with OH."
Reasoning: The aim/objective of the review is explicitly stated, although it does not fully reference the PICOS elements.
Response: [No]
P5
Reasoning: The authors do not indicate if a review protocol exists or where it can be accessed.
Response: [No]
P6
Quote: "Eligibility criteria were all available English language for the full-text review and final analysis. Eligibility criteria included all available studies focused on LH and/or OH and with quantitative data on outcome parameters."
Reasoning: The eligibility criteria are reported, but the rationale is not provided.
Response: [No]
P7
Quote: "A literature search was performed using PubMed, Cochrane, and Medline databases on all studies published during the last 20 years that described open or laparoscopic operation for inguinal hernia, and the latter was compared with conventional OH."
Reasoning: The information sources (databases) are described but the dates of coverage and date last searched are not reported.
Response: [No]
P8
Reasoning: The authors do not present the full electronic search strategy for any of the databases.
Response: [No]
P9
Quote: "The full article was retrieved when the information in the title and/or abstract appeared to meet the objective of our review. The authors independently assessed selected studies and tabulated data from each article with a predefined data extraction form."
Reasoning: The study selection process is described in brief.
Response: [Yes]
P10
Quote: "Data extraction and analysis were independently performed by two authors."
Reasoning: The data extraction process is reported to have been done independently in duplicate.
Response: [Yes]
P11
Quote: "Data regarding the following were considered: first author, publication date, study method, participant features, intervention characteristics, definition of complications, and outcome measures."
Reasoning: The data items collected are listed.
Response: [Yes]
P12
Quote: "The methodological quality of included studies was assessed independently by two authors."
Reasoning: While the authors state that study quality was assessed, the specific methods used are not described.
Response: [No]
P13
Reasoning: The authors do not state the principal summary measures, as this review does not include a quantitative synthesis.
Response: [NA]
P14
Reasoning: This review does not include a meta-analysis, so describing methods for combining results and assessing consistency is not applicable.
Response: [NA]
P15
Reasoning: The authors do not specify any assessment of risk of bias across studies that may affect the cumulative evidence, such as publication bias or selective reporting.
Response: [No]
P16
Reasoning: The authors do not describe any additional analyses, as would be expected since this review does not include a meta-analysis.
Response: [NA]
P17
Quote: "Fifty-three studies matched the inclusion criteria and were selected for the final analysis."
Reasoning: The authors report the number of studies included but do not provide the full PRISMA flow diagram with the number of studies screened and excluded at each stage.
Response: [No]
P18
Quote: "Fifty-three studies matched the inclusion criteria and were selected for the final analysis."
Reasoning: While the number of included studies is reported, a table with the characteristics of each study is not provided.
Response: [No]
P19
Reasoning: The authors state that study quality was independently assessed but do not present the detailed results of the risk of bias assessment for each study.
Response: [No]
P20
Reasoning: The authors report some individual study results in the text and tables but do not systematically present effect estimates and confidence intervals for each study for all outcomes.
Response: [No]
P21
Reasoning: This review does not include a meta-analysis, so presenting the results of each meta-analysis is not applicable.
Response: [NA]
P22
Reasoning: The authors do not present any assessment of risk of bias across studies.
Response: [No]
P23
Reasoning: The authors do not report any additional analyses, as would be expected since this review does not include a meta-analysis.
Response: [NA]
P24
Quote: "In this systematic review, it seems that LH is faster than OH for bilateral hernias, whereas there is no significant difference in terms of operative time for unilateral inguinal hernia repair. Recurrence rate is similar for both techniques. As for other complications, such as wound infections, it is higher for OH compared with LH, especially in infants. A prospective comparative study is necessary on this topic to strongly support the results of our systematic review."
Reasoning: The authors summarize the main findings and their relevance in the discussion section.
Response: [Yes]
P25
Quote: "This review aims to evaluate the role of LH in children and to compare LH with OH in regard to operative time, postoperative complications, recurrence rate, discovering of rare hernias, and incidence of contralateral patency."
Reasoning: The authors discuss some limitations of the review in comparing LH to OH, but do not address limitations at the study level such as risk of bias.
Response: [No]
P26
Quote: "In conclusion, it seems that there is no evidence in literature about which technique (laparoscopy or inguinal approach) is preferable to repair an inguinal hernia. Probably a surgeon has to offer to the patient both techniques, and above all, considering the importance of the parental role in the decision process, the parents have to know that two different approaches exist to repair an inguinal hernia and the advantages and disadvantages of both procedures."
Reasoning: The authors provide a general interpretation of the results in the context of other evidence and implications for practice.
Response: [Yes]
P27
Reasoning: The authors do not describe sources of funding or other support for this systematic review.
Response: [No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
1
|
1
|
1
|
0
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
0
|
1
|
0
|
0
|
0
|
0
|
0
|
1
|
0
|
0
|
0
|
1
|
1
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
0
|
NA
|
1
|
1
|
0
|
1
|
1
|
0
|
NA
|
1
|
1
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
0
|
1
|
1
|
0
|
1
|
1
|
NA
|
NA
|
1
|
0
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
1
|
0
|
0
|
0
|
1
|
0
|
0
|
1
|
0
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
0
|
0
|
0
|
1
|
1
|
1
|
1
|
0
|
0
|
LLM response
16 quote(s) from
publication full text (mean similarity 99.6%)
A1
Quote: "Literature searches were conducted to identify studies having compared the laparoscopic splenectomy (LS) and open splenectomy (OS) for children."
Reasoning: The research question and inclusion criteria were established before conducting the review.
[Yes]
A2
Quotes: "Included studies were independently reviewed by two reviewers, and a third reviewer was required for a final decision in the case of any discrepancies. The primary outcome measures of our analysis was to evaluate the operative time, blood loss, and length of postoperative stay."
Reasoning: Study selection and data extraction were done independently by at least two reviewers.
[Yes]
A3
Quote: "Published records were searched using the MEDLINE, EMBASE, and Web of Science from 1993 to 2015."
Reasoning: At least two electronic databases were searched.
[No] - No supplementary strategies like reviewing references, consulting experts, or searching specialized registers were mentioned.
A4
Reasoning: The authors did not state that they searched for reports regardless of publication type or whether any reports were excluded based on publication status or language.
[No]
A5
Reasoning: A list of included and excluded studies was not provided in the article.
[No]
A6
Quotes: See Tables 1, 2 and 3 which provide aggregate data on participant characteristics, interventions and outcomes.
Reasoning: Characteristics of the included studies were provided in aggregate form in tables.
[Yes]
A7
Quote: "For dichotomous data, we calculated odds ratios (ORs). Statistical heterogeneity in the meta-analysis was assessed with the χ2 test and the I2 index. A random-effects model was used in case of heterogeneous data. Otherwise, a fixed-effects model was used instead."
Reasoning: The scientific quality of included studies was assessed using statistical methods.
[Yes]
A8
Quote: "In conclusion, our study suggests that LS is a feasible, safe, and effective surgical procedure alternative to OS for pediatric patients. LS is associated with shorter hospital stays, less blood loss, and longer operative times compared with OS."
Reasoning: The results of the methodological rigor and scientific quality were considered in formulating the conclusions and recommendations.
[Yes]
A9
Quotes: "For dichotomous data, we calculated odds ratios (ORs). Statistical heterogeneity in the meta-analysis was assessed with the χ2 test and the I2 index. A random-effects model was used in case of heterogeneous data. Otherwise, a fixed-effects model was used instead."
Reasoning: Appropriate methods were used to combine findings, assessing heterogeneity and using a random-effects model for heterogeneous data.
[Yes]
A10
Reasoning: The likelihood of publication bias was not assessed.
[No]
A11
Reasoning: Potential sources of support or conflicts of interest were not acknowledged for the systematic review or the included studies.
[No]
P1
Quote: "Laparoscopic versus open splenectomy in children: a systematic review and meta-analysis"
Reasoning: The title identifies the article as a systematic review and meta-analysis.
[Yes]
P2
Reasoning: The article has an abstract but it is not structured with distinct labeled sections for background, objectives, data sources, etc.
[No]
P3
Quote: "Splenectomy is occasionally performed in children with various hematologic disorders such as sickle cell disease, idiopathic thrombocytopenic purpura, and so on [1]. Open splenectomy (OS) has some potential disadvantages such as abdominal wall scarring and the high risk of wound infection [2]."
Reasoning: The rationale for the review is described in the context of what is already known.
[Yes]
P4
Quote: "The primary outcome measures of our analysis was to evaluate the operative time, blood loss, and length of postoperative stay."
Reasoning: The questions being addressed specify the outcomes, but do not explicitly mention the participants, interventions, comparisons or study design.
[No]
P5
Reasoning: The article does not indicate if a review protocol exists or where it can be accessed.
[No]
P6
Reasoning: Study characteristics (participants, interventions, comparisons, outcomes) and report characteristics used as criteria for eligibility were not specified.
[No]
P7
Quote: "Published records were searched using the MEDLINE, EMBASE, and Web of Science from 1993 to 2015."
Reasoning: The information sources and dates of coverage are described but the date last searched is not provided.
[No]
P8
Reasoning: The full electronic search strategy is not presented such that it could be repeated.
[No]
P9
Quote: "Studies comparing LS and OS in children were included regardless of randomization or non-randomization. Inclusion criteria: (1) clinical trials that compared laparoscopic versus open splenectomy between 1993 and 2015; (2) children under 18 years old who suffered from benign or malignant hematological diseases; exclusion criteria: (1) no open splenectomy as a control; (2) reports fewer than ten cases per group; and (3) studies did not provide available original data or duplicate publications."
Reasoning: The process for selecting studies is stated.
[Yes]
P10
Quote: "Included studies were independently reviewed by two reviewers, and a third reviewer was required for a final decision in the case of any discrepancies."
Reasoning: The data extraction process is described but there is no mention of piloted forms or processes for obtaining and confirming data from investigators.
[No]
P11
Reasoning: The article does not list and define all variables for which data were sought.
[No]
P12
Reasoning: The article does not describe methods used for assessing risk of bias in individual studies.
[No]
P13
Quote: "For dichotomous data, we calculated odds ratios (ORs)."
Reasoning: Odds ratio is stated as the principal summary measure.
[Yes]
P14
Quote: "Statistical heterogeneity in the meta-analysis was assessed with the χ2 test and the I2 index. A random-effects model was used in case of heterogeneous data. Otherwise, a fixed-effects model was used instead."
Reasoning: The methods of handling data and combining results are described, including measures of consistency.
[Yes]
P15
Reasoning: The article does not specify any assessment of risk of bias that may affect the cumulative evidence.
[No]
P16
Reasoning: No additional analyses such as sensitivity analysis or meta-regression are described.
[No]
P17
Quote: See Figure 1 flow diagram.
Reasoning: A flow diagram is provided giving the numbers of studies screened, assessed for eligibility, and included with reasons for exclusions at each stage.
[Yes]
P18
Quotes: See Tables 1, 2 and 3.
Reasoning: For each included study, characteristics are presented including participant demographics, interventions, and outcome data along with citations.
[Yes]
P19
Reasoning: The article does not present data on risk of bias for each included study.
[No]
P20
Quotes: See forest plots in Figures 2-5.
Reasoning: For each outcome, simple summary data for each group and effect estimates with confidence intervals are presented in forest plots.
[Yes]
P21
Quotes: See forest plots in Figures 2-5.
Reasoning: The results of each meta-analysis are presented with confidence intervals and measures of consistency.
[Yes]
P22
[NA] - No assessment of risk of bias across studies was described.
P23
[NA] - No additional analyses were described.
P24
Quote: "In conclusion, our study suggests that LS is a feasible, safe, and effective surgical procedure alternative to OS for pediatric patients. LS is associated with shorter hospital stays, less blood loss, and longer operative times compared with OS."
Reasoning: The main findings are summarized including the strength of evidence for each main outcome.
[Yes]
P25
Quote: "On one hand, obvious heterogeneity was detected among different trials in terms of operative time, blood loss, and length of hospital stay."
Reasoning: Some limitations at the review level are discussed, but limitations at the study and outcome level are not.
[No]
P26
Quote: "In conclusion, our study suggests that LS is a feasible, safe, and effective surgical procedure alternative to OS for pediatric patients. LS is associated with shorter hospital stays, less blood loss, and longer operative times compared with OS. Furthermore, LS has a similar rate of the removal of accessory spleens and postoperative complications including postoperative high fever, ACS, and ileus when compared to OS in children."
Reasoning: A general interpretation of the results is provided in the context of other evidence and implications for future practice.
[Yes]
P27
Reasoning: Sources of funding for the systematic review are not described.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
1
|
1
|
1
|
0
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
0
|
0
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
0
|
NA
|
1
|
1
|
0
|
1
|
1
|
0
|
NA
|
1
|
0
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
0
|
1
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
0
|
0
|
0
|
1
|
1
|
1
|
1
|
0
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
0
|
1
|
0
|
0
|
1
|
1
|
1
|
1
|
0
|
0
|
LLM response
29 quote(s) from
publication full text (mean similarity 96.1%)
A1. Was an 'a priori' design provided?
Quotes: None relevant
Reasoning: The article does not mention a protocol, ethics approval, or pre-determined objectives.
[No]
A2. Was there duplicate study selection and data extraction?
Quotes: "The first author independently extracted data from the included studies. Details of publication (type of reporting the internal ring, trocars, and follow-up duration), inclusion and exclusion criteria, and demographics of the enrolled patients were collected and collated. Quality of the RCTs was assessed, including randomization, method of blinding, and allocation concealment."
Reasoning: Data extraction was done by one author, but no mention of duplicate study selection.
[No]
A3. Was a comprehensive literature search performed?
Quotes: "We systematically searched PubMed for relevant studies reported from 2005 to 2014 with the keywords "laparoscopic herniorrhaphy", "pediatric inguinal hernia," and "open herniorrhaphy." Total reference lists of selected articles were also included. We limited our searches to the publications written in English."
Reasoning: At least 2 electronic databases (PubMed and reference lists) were searched with keywords provided.
[Yes]
A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion?
Quotes: None relevant
Reasoning: No mention of including grey literature or unpublished studies.
[No]
A5. Was a list of studies (included and excluded) provided?
Quotes: "Articles excluded because of failure to meet inclusion criteria (n = 235)"
Reasoning: A flow diagram shows the number of excluded studies, but no list is provided.
[No]
A6. Were the characteristics of the included studies provided?
Quotes: "Table 1. Study Details of Total Randomized Clinical Trials"
Reasoning: Key characteristics of the included studies are provided in an aggregated table.
[Yes]
A7. Was the scientific quality of the included studies assessed and documented?
Quotes: "Quality of the RCTs was assessed, including randomization, method of blinding, and allocation concealment."
"Table 2. Quality Check of Total Randomized Clinical Trials"
Reasoning: The quality of included studies was assessed using specified criteria and the results are provided in a table.
[Yes]
A8. Was the scientific quality of the included studies used appropriately in formulating conclusions?
Quotes: "Despite no significant difference was observed regarding the recurrence, LH can be accepted as the standard of care as long as total postoperative complications was substantially reduced, especially for major postoperative complications in male children."
Reasoning: The quality assessment results were considered when interpreting the findings and drawing conclusions.
[Yes]
A9. Were the methods used to combine the findings of studies appropriate?
Quotes: "Weighted mean differences and 95% confidence intervals (CI) were calculated for continuous variables and dichotomous variables, respectively. The confidence interval (CI) was established at 95%. Statistical heterogeneity in the meta-analysis was assessed with the χ2 test and the I2 index. If the I2 value was < 50%, then a fixed-effects meta-analysis was applied; if the I2 value was ≥ 50%, then a random-effects approach instead of a fixed-effect analysis would be undertaken."
Reasoning: Appropriate statistical methods were used to combine the study findings, assessing and accounting for heterogeneity.
[Yes]
A10. Was the likelihood of publication bias assessed?
Quotes: None relevant
Reasoning: The article does not mention assessing for publication bias.
[No]
A11. Was the conflict of interest included?
Quotes: "S.F. and L.Z. contributed equally to the manuscript. The authors declare no conflict of interest."
Reasoning: Conflicts of interest for the systematic review authors are reported, but not for the included studies.
[No]
P1. Title: Identify the report as a systematic review, meta-analysis, or both.
Quotes: "Open Versus Laparoscopic Inguinal Herniotomy in Children: A Systematic Review and Meta-Analysis Focusing on Postoperative Complications"
Reasoning: The title identifies the article as a systematic review and meta-analysis.
[Yes]
P2. Abstract / Structured summary
Quotes: The abstract contains labeled sections for Purpose, Methods, Results, Conclusions, and Key Words.
Reasoning: The abstract is structured with distinct sections covering the main elements.
[Yes]
P3. Introduction / Rationale
Quotes: "There is an ongoing debate about whether laparoscopic or open herniorrhaphy (LH or OH) is the best choice for inguinal hernia in children. The aim of this study was to compare both of the surgical strategies as regards operative time, recurrence rate, postoperative complications by means of a systematic review, and meta-analysis of the available literatures."
Reasoning: The introduction describes the rationale for conducting the review in the context of the ongoing debate.
[Yes]
P4. Introduction / Objectives
Quotes: "The aim of this study was to compare both of the surgical strategies as regards operative time, recurrence rate, postoperative complications by means of a systematic review, and meta-analysis of the available literatures."
Reasoning: The objectives are stated, mentioning the outcomes of interest and the synthesis methods.
[Yes]
P5. Methods / Protocol and registration
Quotes: None relevant
Reasoning: No mention of a review protocol or registration.
[No]
P6. Methods / Eligibility criteria
Quotes: "Total postoperative complications were significantly reduced in LH, especially for major postoperative complications in male children."
Reasoning: The eligibility criteria are briefly described, focusing on postoperative complications in male children.
[No]
P7. Methods / Information sources
Quotes: "We systematically searched PubMed for relevant studies reported from 2005 to 2014 with the keywords "laparoscopic herniorrhaphy", "pediatric inguinal hernia," and "open herniorrhaphy." Total reference lists of selected articles were also included. We limited our searches to the publications written in English."
Reasoning: PubMed and reference lists were searched up to 2014.
[Yes]
P8. Methods / Search
Quotes: "We systematically searched PubMed for relevant studies reported from 2005 to 2014 with the keywords "laparoscopic herniorrhaphy", "pediatric inguinal hernia," and "open herniorrhaphy.""
Reasoning: The search keywords are provided but the full search strategy for PubMed is not presented.
[No]
P9. Methods / Study selection
Quotes: "Our search was restricted to RCTs. Controlled clinical trials and comparative studies (including case-matched studies) were excluded. Eligibility criteria included total available studies comparing LH with OH for the repair of PIH. The children were younger than 18 years when they underwent LH or OH. The postoperative complications include postoperative vomiting, hydrocele, recurrence, iatrogenic ascent of the testis, testicular atrophy, scrotal edema, stitch granuloma, ugly scar and some of the complications are unique in male such as iatrogenic ascent of the testis and testicular atrophy. Two reviewers (S.F., Z.L.) screened the citation identified by the search strategy."
Reasoning: The study selection process is described, including eligibility criteria and involvement of two reviewers.
[Yes]
P10. Methods / Data collection process
Quotes: "The first author independently extracted data from the included studies. Details of publication (type of reporting the internal ring, trocars, and follow-up duration), inclusion and exclusion criteria, and demographics of the enrolled patients were collected and collated."
Reasoning: Data extraction was performed by one author using a data collection form.
[Yes]
P11. Methods / Data items
Quotes: "Details of publication (type of reporting the internal ring, trocars, and follow-up duration), inclusion and exclusion criteria, and demographics of the enrolled patients were collected and collated."
Reasoning: The data items collected are described.
[Yes]
P12. Methods / Risk of bias in individual studies
Quotes: "Quality of the RCTs was assessed, including randomization, method of blinding, and allocation concealment."
Reasoning: The methods for assessing risk of bias in the included RCTs are described.
[Yes]
P13. Methods / Summary measures
Quotes: "Weighted mean differences and 95% confidence intervals (CI) were calculated for continuous variables and dichotomous variables, respectively."
Reasoning: The summary measures (weighted mean differences, 95% CI) are specified.
[Yes]
P14. Methods / Synthesis of results
Quotes: "Statistical heterogeneity in the meta-analysis was assessed with the χ2 test and the I2 index. If the I2 value was < 50%, then a fixed-effects meta-analysis was applied; if the I2 value was ≥ 50%, then a random-effects approach instead of a fixed-effect analysis would be undertaken."
Reasoning: The methods for data synthesis are described, including assessing heterogeneity and using fixed or random effects models as appropriate.
[Yes]
P15. Methods / Risk of bias across studies
Quotes: None relevant
Reasoning: No methods for assessing risk of bias across studies (e.g. publication bias) are mentioned.
[No]
P16. Methods / Additional analyses
Quotes: None relevant
Reasoning: No additional analyses such as subgroup analyses or meta-regression are mentioned.
[No]
P17. Results / Study selection
Quotes: "The initial search strategy identified 249 citations and 14 of them were retrieved for full-text review. Five trials met the total inclusion criteria and had no exclusion criteria (Fig. 1): Chan et al,28 Koivusalo et al,29 Celebi et al,30 Shalaby et al,31 and Saranga et al.32 The 5 selected trials included 553 participants. Two hundred and seventy-eight patients received OH and 275 received LH. Study details are given in Table 1."
Reasoning: The number of studies screened, assessed for eligibility, and included are provided, with reasons for exclusions shown in a flow diagram.
[Yes]
P18. Results / Study characteristics
Quotes: "Table 1. Study Details of Total Randomized Clinical Trials"
Reasoning: The characteristics of the included studies are provided in a table with citations.
[Yes]
P19. Results / Risk of bias within studies
Quotes: "Table 2. Quality Check of Total Randomized Clinical Trials"
Reasoning: The results of the risk of bias assessment for each included study are presented in a table.
[Yes]
P20. Results / Results of individual studies
Quotes: The results for individual studies are provided in the forest plots in Figures 2-6.
Reasoning: Effect estimates and confidence intervals for each study are provided in the forest plots for all outcomes.
[Yes]
P21. Results / Synthesis of results
Quotes: The forest plots in Figures 2-6 show the pooled results.
Reasoning: The results of the meta-analyses with confidence intervals and measures of consistency are provided in the forest plots.
[Yes]
P22. Results / Risk of bias across studies
Quotes: None relevant
Reasoning: No results of assessment of risk of bias across studies (e.g. publication bias) are reported.
[No]
P23. Results / Additional analysis
Quotes: The forest plots in Figures 2-6 show results for subgroups.
Reasoning: The results of subgroup analyses are provided in the forest plots.
[Yes]
P24. Discussion / Summary of evidence
Quotes: "In this systematic review we summarized total RCTs available in the pediatric surgical literature, focusing on operative time, postoperative complications, and recurrence. Our results show that LH is superior for the inguinal hernia repair in children, with shorter operative time for unilateral hernias in extraperitoneal approaches group as well as for bilateral hernias. Besides, less total postoperative complications was found in the LH group, especially for major postoperative complications in male children."
Reasoning: The main findings are summarized, considering their relevance to pediatric surgical practice.
[Yes]
P25. Discussion / Limitations
Quotes: "Yet there are no significant difference regarding the recurrence rates between laparoscopic and open group. However, on one hand, because of the limited number of patients and studies, more RCTs need to be conducted to confirm these findings; on the other hand, the learning curve in the 5 RCTs may play an underestimated role in the study, which may weaken the results of the comparison."
Reasoning: Limitations of the small number of studies and patients as well as the learning curve are discussed.
[Yes]
P26. Discussion / Conclusions
Quotes: "In this systematic review we summarized total RCTs available in the pediatric surgical literature, focusing on operative time, postoperative complications, and recurrence. Our results show that LH is superior for the inguinal hernia repair in children, with shorter operative time for unilateral hernias in extraperitoneal approaches group as well as for bilateral hernias. Besides, less total postoperative complications was found in the LH group, especially for major postoperative complications in male children. Yet there is no significant difference regarding the recurrence. However, on one hand, because of the limited number of patients and studies, more RCTs need to be conducted to confirm these findings; on the other hand, the learning curve in the 5 RCTs may play an underestimated role in the study, which may weaken the results of the comparison."
Reasoning: The conclusions provide a general interpretation of the results and implications for future research.
[Yes]
P27. Funding
Quotes: "The authors declare no conflict of interest."
Reasoning: The authors declare no conflicts, but sources of funding for the systematic review are not described.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
1
|
0
|
1
|
0
|
0
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
0
|
1
|
1
|
0
|
0
|
1
|
0
|
0
|
0
|
1
|
0
|
0
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
0
|
NA
|
0
|
1
|
0
|
0
|
0
|
0
|
NA
|
0
|
0
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
NA
|
NA
|
0
|
0
|
0
|
0
|
NA
|
NA
|
NA
|
0
|
0
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
1
|
0
|
0
|
1
|
0
|
0
|
0
|
0
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
0
|
1
|
0
|
0
|
1
|
0
|
NA
|
NA
|
NA
|
0
|
LLM response
14 quote(s) from
publication full text (mean similarity 99.7%)
A1 - Was an 'a priori' design provided?
Quote: "A meta-analysis of redo PT operations for HD reported in the literature between 1985 and 2011 was performed. Detailed information was recorded in patients with RA and transition-zone bowel (TZB), including recurrent bowel problems, histological findings on repeat rectal biopsy, type of redo PT operation and outcome."
The authors specified the research question and inclusion criteria. [Yes]
A2 - Was there duplicate study selection and data extraction?
No relevant quotes found. The methods do not mention duplicate study selection and data extraction. [No]
A3 - Was a comprehensive literature search performed?
Quote: "PubMed and MEDLINE databases were searched for all studies that reported cases of patients with HD who had undergone redo PT operations for RA or transition-zone bowel (TZB) after initial operation between 1985 and 2011."
At least 2 databases were searched with search terms and date ranges. [Yes]
A4 - Was the status of publication (i.e. grey literature) used as an inclusion criterion?
No relevant quotes found. The methods do not mention including grey literature or unpublished studies. [No]
A5 - Was a list of studies (included and excluded) provided?
The article contains a table (Table 1) listing the 24 included studies. However, no list of excluded studies is provided. [No]
A6 - Were the characteristics of the included studies provided?
Quote: "Twenty-nine articles reported 555 patients with HD who underwent redo PT operation. 193 (34.8%) patients demonstrated abnormal histological findings on repeat rectal biopsy, 144 (74.6%) patients revealed RA and 49 (25.4%) patients TZB (Table 1)."
The article provides aggregate characteristics of the included studies. [Yes]
A7 - Was the scientific quality of the included studies assessed and documented?
No relevant quotes found. The article does not mention assessing or reporting the quality of included studies. [No]
A8 - Was the scientific quality of the included studies used appropriately in formulating conclusions?
Not applicable, as the scientific quality of included studies was not assessed (A7). [NA]
A9 - Were the methods used to combine the findings of studies appropriate?
Not applicable, as this systematic review did not perform a meta-analysis. [NA]
A10 - Was the likelihood of publication bias assessed?
Not applicable, as this systematic review did not perform a meta-analysis. [NA]
A11 - Was the conflict of interest included?
No relevant quotes found. The article does not report sources of funding or conflicts of interest for the systematic review or included studies. [No]
P1 - Title
Quote: "Residual aganglionosis after pull-through operation for Hirschsprung's disease: a systematic review and meta-analysis"
The title identifies the article as a systematic review and meta-analysis. [Yes]
P2 - Abstract / Structured summary
The abstract contains labeled sections covering the background, methods, results, and conclusions. However, it is missing some elements like the full PICOS and registration number. [No]
P3 - Introduction / Rationale
Quote: "Over the years, various PT operations have been used to treat patients with HD [18–23]. It has been shown in several studies that there is no statistically significant difference in the functional outcome with respect to bowel function between the various PT procedures [24–27]."
The introduction describes the rationale for the review in the context of what is known. [Yes]
P4 - Introduction / Objectives
Quote: "We designed this meta-analysis to determine the incidence and outcome of residual aganglionosis (RA) in patients with HD following PT operation."
The introduction provides an explicit statement of the review question. [Yes]
P5 - Methods / Protocol and registration
No relevant quotes found. The article does not mention a protocol or registration. [No]
P6 - Methods / Eligibility criteria
Quote: "The search terms were "residual aganglionosis", "transition-zone bowel", "redo and repeat pull-through", "reoperation Hirschsprung's disease" and "postoperative follow-up and outcome Hirschsprung's disease"."
The methods section specifies the search terms used as eligibility criteria. However, it does not fully describe the PICOS and rationale. [No]
P7 - Methods / Information sources
Quote: "PubMed and MEDLINE databases were searched for all studies that reported cases of patients with HD who had undergone redo PT operations for RA or transition-zone bowel (TZB) after initial operation between 1985 and 2011."
The databases searched and dates of coverage are reported. [Yes]
P8 - Methods / Search
Quote: "The search terms were "residual aganglionosis", "transition-zone bowel", "redo and repeat pull-through", "reoperation Hirschsprung's disease" and "postoperative follow-up and outcome Hirschsprung's disease"."
The full search strategy is not provided, only the search terms used. [No]
P9 - Methods / Study selection
Quote: "Detailed information was recorded regarding type of study, gender, recurrent bowel symptoms, histological findings on repeat rectal biopsy, patient's age at initial PT and redo PT operation, type of surgical procedures performed and postoperative follow-up with recurrent symptoms."
The article describes the information extracted but not the full process for study screening and selection. [No]
P10 - Methods / Data collection process
No relevant quotes found. The data collection process is not described. [No]
P11 - Methods / Data items
Quote: "Detailed information was recorded regarding type of study, gender, recurrent bowel symptoms, histological findings on repeat rectal biopsy, patient's age at initial PT and redo PT operation, type of surgical procedures performed and postoperative follow-up with recurrent symptoms."
The article lists the data items collected. [Yes]
P12 - Methods / Risk of bias in individual studies
No relevant quotes found. Assessment of risk of bias in individual studies is not described. [No]
P13 - Methods / Summary measures
No relevant quotes found. The article does not state the principal summary measures. [No]
P14 - Methods / Synthesis of results
Not applicable, as this systematic review did not perform a meta-analysis. [NA]
P15 - Methods / Risk of bias across studies
Not applicable, as this systematic review did not perform a meta-analysis. [NA]
P16 - Methods / Additional analyses
Not applicable, as this systematic review did not perform a meta-analysis. [NA]
P17 - Results / Study selection
Quote: "Between 1985 and 2011, 29 published articles reported 555 patients with HD who underwent redo PT operation. 193 (34.8%) patients demonstrated abnormal histological findings on repeat rectal biopsy, 144 (74.6%) patients revealed RA and 49 (25.4%) patients TZB (Table 1)."
The number of included studies and patients is reported. However, the number of studies screened and excluded with reasons is not provided, ideally with a flow diagram. [No]
P18 - Results / Study characteristics
Quote: "24 articles (82.8%) were from single centers, and 5 (17.2%) were from multicenter studies."
The article reports some aggregate characteristics of included studies. However, characteristics of each individual study are not presented with citations. [No]
P19 - Results / Risk of bias within studies
No relevant quotes found. Results of risk of bias assessment for individual studies are not reported. [No]
P20 - Results / Results of individual studies
No relevant quotes found. Results are not presented for each individual study. [No]
P21 - Results / Synthesis of results
Not applicable, as this systematic review did not perform a meta-analysis. [NA]
P22 - Results / Risk of bias across studies
Not applicable, as this systematic review did not perform a meta-analysis. [NA]
P23 - Results / Additional analysis
Not applicable, as this systematic review did not perform a meta-analysis. [NA]
P24 - Discussion / Summary of evidence
Quote: "Our meta-analysis reveals that RA and TZB are the underlying causes of persistent bowel symptoms in one-third of all patients requiring redo PT operation."
The discussion summarizes the main findings. However, it does not address the strength of evidence for each main outcome. [No]
P25 - Discussion / Limitations
Quote: "One major problem with the intraoperative frozen section biopsies is that it can indicate the presence of ganglion cells without differentiating between hypo- and dysganglionosis [29]."
The discussion mentions some limitations but does not cover limitations at the study, outcome, and review levels. [No]
P26 - Discussion / Conclusions
Quote: "A redo PT operation for RA or TZB is potentially preventable by accurate identification of the proximal margin of the aganglionic bowel and transition-zone by an experienced histopathologist [28]."
The conclusion provides an interpretation of the results with implications for practice. [Yes]
P27 - Funding
No relevant quotes found. Sources of funding for the systematic review are not reported. [No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
1
|
0
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
1
|
0
|
1
|
1
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
0
|
NA
|
1
|
1
|
0
|
1
|
0
|
0
|
NA
|
0
|
0
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
0
|
1
|
1
|
0
|
1
|
1
|
0
|
0
|
1
|
1
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
0
|
0
|
0
|
1
|
0
|
0
|
1
|
0
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
0
|
1
|
0
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
LLM response
22 quote(s) from
publication full text (mean similarity 99.2%)
A1
Quote: "A systematic literature search was conducted for relevant articles published between 1981 and 2011, and a meta-analysis of complications and long-term outcome was performed."
Reasoning: The authors mention conducting a systematic literature search for articles published between 1981 and 2011, indicating an a priori design.
[Yes]
A2
No relevant quotes found.
Reasoning: The authors do not mention duplicate study selection and data extraction.
[No]
A3
Quotes: "A systematic literature search was performed to identify articles reporting cases of LGEA managed by DPA. Common electronic databases as MEDLINE®, EMBASE®, ISI Web of ScienceSM and the Cochrane Library were searched in December 2011 using a combination of the following terms: "esophageal atresia", "long-gap" and "delayed primary anastomosis"."
Reasoning: The authors searched multiple electronic databases and provided the search terms used.
[Yes]
A4
No relevant quotes found.
Reasoning: The authors do not mention whether they included grey literature or unpublished studies.
[No]
A5
No relevant quotes found.
Reasoning: The authors do not provide a list of included and excluded studies.
[No]
A6
Quote: "The overall number of study subjects managed by DPA was 451, ranging from 1 to 74 newborns with LGEA per study. Study and patients characteristics are presented in Table 1."
Reasoning: The authors provide an aggregated table (Table 1) with characteristics of the included studies.
[Yes]
A7
Quote: "An unblinded, standardized full-text assessment of relevant articles was independently performed by both authors (F.F. and P.P.). The data was extracted into an electronic data-sheet in a standardized manner."
Reasoning: The authors independently assessed the full-text of relevant articles.
[Yes]
A8
No relevant quotes found.
Reasoning: The authors do not explicitly state that they considered methodological rigor or scientific quality in formulating conclusions and recommendations.
[No]
A9
Quote: "A cumulative meta-analysis revealed the incidences for each specific complication (Table 2). Since not all complications were reported in all articles, each specific complication was recorded as the number of patients in which that complication was present divided by the total number of patients in the cohorts that presented data on that specific complication."
Reasoning: The authors used appropriate methods to combine the findings, taking into account the number of patients for each complication.
[Yes]
A10
No relevant quotes found.
Reasoning: The authors do not mention assessing the likelihood of publication bias.
[No]
A11
No relevant quotes found.
Reasoning: The authors do not report the sources of funding or conflicts of interest for the included studies.
[No]
P1
Quote: "Delayed primary anastomosis for management of long-gap esophageal atresia: a meta-analysis of complications and long-term outcome"
Reasoning: The title identifies the article as a meta-analysis.
[Yes]
P2
Quote: See structured abstract on page 1.
Reasoning: The article provides a structured abstract with labeled sections for background, methods, results, and conclusion.
[Yes]
P3
Quote: "Esophageal atresia (EA) is a relatively common congenital malformation of unknown etiology with an incidence of 1 in 3,500 live births [1]. Pure EA without tracheoesophageal fistula (Fig. 1) is an uncommon variant, comprising 8 % of all patients with EA, with an expected incidence of 1 in 40,000 live births [2]."
Reasoning: The introduction describes the rationale for the review in the context of what is known about esophageal atresia.
[Yes]
P4
Quote: "Purpose Management of newborns with long-gap esophageal atresia (LGEA) remains a challenge for pediatric surgeons. Since spontaneous growth of the esophageal segments occurs without mechanical stretching, initial gastrostomy followed by delayed primary anastomosis (DPA) comprises treatment in most LGEA patients. This meta-analysis aimed to investigate the complications and long-term outcome in patients with LGEA managed by DPA."
Reasoning: The purpose statement provides an explicit statement of the question being addressed, referencing the population (newborns with LGEA), intervention (DPA), and outcomes of interest (complications and long-term outcome).
[Yes]
P5
No relevant quotes found.
Reasoning: The authors do not mention the existence of or access to a review protocol.
[No]
P6
Quote: "Identified articles were reviewed by title, keywords and abstract by one of the authors (F.F.). All articles that did not contain original research data (e.g. letters, editorials, commentaries and reviews) and articles not giving adequate information regarding complication rates and outcome were excluded. Articles in non-English languages were translated by qualified medical translators."
Reasoning: The authors specify the study characteristics used as criteria for eligibility.
[Yes]
P7
Quote: "A systematic literature search was performed to identify articles reporting cases of LGEA managed by DPA. Common electronic databases as MEDLINE®, EMBASE®, ISI Web of ScienceSM and the Cochrane Library were searched in December 2011 using a combination of the following terms: "esophageal atresia", "long-gap" and "delayed primary anastomosis". References lists of identified articles were screened for additional studies. There were no language or publication date restrictions. Duplicated articles were deleted."
Reasoning: The authors describe the databases searched, search terms used, and the date of the search.
[Yes]
P8
No relevant quotes found.
Reasoning: The authors do not present the full electronic search strategy such that it could be repeated.
[No]
P9
Quote: "An unblinded, standardized full-text assessment of relevant articles was independently performed by both authors (F.F. and P.P.). The data was extracted into an electronic data-sheet in a standardized manner."
Reasoning: The authors state the process for selecting studies, including full-text assessment by two authors independently.
[Yes]
P10
Quote: "Data extracted from each participating article included study characteristics (first author, publication year, sample size, follow-up time and mortality rate) and patient characteristics (gestational age, birth weight, type of LGEA and additional congenital anomalies). The primary outcome of this analysis was complication rates."
Reasoning: The authors describe the method of data extraction from each article.
[Yes]
P11
Quote: "Data extracted from each participating article included study characteristics (first author, publication year, sample size, follow-up time and mortality rate) and patient characteristics (gestational age, birth weight, type of LGEA and additional congenital anomalies)."
Reasoning: The authors list the variables for which data were sought from each study.
[Yes]
P12
Quote: "An unblinded, standardized full-text assessment of relevant articles was independently performed by both authors (F.F. and P.P.)."
Reasoning: The authors mention independently assessing the full-text of articles, but do not describe specific methods for assessing risk of bias.
[No]
P13
Quote: "Associations between complications were presented by relative risk (RR) and their 95 % CI. Statistical differences were considered as significant for a p value <0.05 (two-tailed)."
Reasoning: The authors state the principal summary measures as relative risk and 95% confidence intervals.
[Yes]
P14
Quote: "A cumulative meta-analysis revealed the incidences for each specific complication (Table 2). Since not all complications were reported in all articles, each specific complication was recorded as the number of patients in which that complication was present divided by the total number of patients in the cohorts that presented data on that specific complication. With these data, a cumulative meta-analysis was performed. This enabled the calculation of incidences with a 95 % confidence interval (CI) for each specific complication."
Reasoning: The authors describe the methods used for combining results in the meta-analysis, including calculating incidences and 95% confidence intervals for each complication.
[Yes]
P15
No relevant quotes found.
Reasoning: The authors do not mention assessing risk of bias across studies, such as publication bias or selective reporting.
[No]
P16
No relevant quotes found.
Reasoning: The authors do not describe any additional analyses.
[No]
P17
Quote: See Figure 2 flow diagram.
Reasoning: The authors provide a flow diagram showing the number of studies screened, assessed for eligibility, and included, with reasons for exclusions at each stage.
[Yes]
P18
Quote: See Table 1.
Reasoning: The authors provide a table (Table 1) presenting the characteristics of each included study.
[Yes]
P19
No relevant quotes found.
Reasoning: The authors do not present data on the risk of bias for each included study.
[No]
P20
Quote: See Table 2.
Reasoning: The authors present data for each complication in Table 2, including the number of studies, subjects, and incidence with 95% confidence interval.
[Yes]
P21
Quote: "A cumulative meta-analysis revealed the incidences for each specific complication (Table 2)."
Reasoning: The authors present the results of the meta-analysis in Table 2, including incidences and 95% confidence intervals for each complication.
[Yes]
P22
No relevant quotes found.
Reasoning: The authors do not report assessing risk of bias across studies.
[No]
P23
No relevant quotes found.
Reasoning: The authors do not report any additional analyses.
[No]
P24
Quote: "DPA provides good long-term functional results. However, the high incidence of GER and associated strictures requires early intervention to prevent feeding problems."
Reasoning: The authors summarize the main findings in the conclusion.
[Yes]
P25
Quote: "The disadvantage of waiting for the esophageal segments to grow and hypertrophy is prolonged hospital stay and constant threat of aspiration pneumonia, which requires continuous skilled nursing supervision [21]. It may also be argued that the initial prolonged hospitalization is expensive."
Reasoning: The authors discuss some limitations of the DPA approach.
[Yes]
P26
Quote: "In conclusion, this meta-analysis shows that the DPA provides good long-term functional results. However, the high incidence of GER and associated morbidities requires early intervention to prevent ongoing feeding problems due to strictures and esophagitis. Long-term follow-up is recommended because of the potential risk of Barrett's metaplasia."
Reasoning: The authors provide a general interpretation of the results and implications for long-term follow-up.
[Yes]
P27
Quote: "Conflict of interest The authors declare that they have no conflict of interests."
Reasoning: The authors declare they have no conflicts of interest, but do not describe sources of funding for the systematic review.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
1
|
1
|
1
|
0
|
NA
|
NA
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
0
|
0
|
1
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
1
|
1
|
0
|
NA
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
NA
|
NA
|
1
|
1
|
NA
|
0
|
NA
|
NA
|
NA
|
1
|
0
|
1
|
1
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
0
|
0
|
0
|
1
|
0
|
0
|
NA
|
NA
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
1
|
1
|
0
|
1
|
1
|
0
|
NA
|
NA
|
NA
|
0
|
LLM response
22 quote(s) from
publication full text (mean similarity 99.7%)
A1. Was an 'a priori' design provided?
Quotes: None relevant.
Reasoning: No mention of a protocol, ethics approval, or pre-determined objectives.
[No]
A2. Was there duplicate study selection and data extraction?
Quotes: "Any disagreement during study selection and data extraction process was resolved by discussion between first author (GF) and senior authors (AM, SHC)."
Reasoning: Study selection and data extraction were done in duplicate with a consensus process.
[Yes]
A3. Was a comprehensive literature search performed?
Quotes: "A systematic literature search was carried out using the search terms "bowel lengthening", "intestinal lengthening", "longitudinal intestinal lengthening and tailoring", "LILT", "Bianchi procedure", "serial transverse enteroplasty" and "step procedure". The last search was done on December, 10th, 2012. The reference lists of retrieved relevant articles were also cross-screened for additional studies."
Reasoning: At least 2 sources (reference lists and unspecified databases) plus a supplementary strategy (cross-referencing) were used.
[Yes]
A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion?
Quotes: None relevant.
Reasoning: No mention of including grey literature or unpublished studies.
[No]
A5. Was a list of studies (included and excluded) provided?
Quotes: "Fig. 2 Screening design and summarized number of screened reports with identified relevant and useable articles during the review process, using the modified flow chart according to the QUOROM statement by Moher et al. [10]."
Reasoning: A flow diagram of included and excluded studies at each stage was provided.
[Yes]
A6. Were the characteristics of the included studies provided?
Quotes: "Table 1 List of evaluated and reviewed STEP (n = 109) and LILT (n = 363) procedures in published case reports from 1991 to 2012."
Reasoning: Characteristics of included studies were provided in an aggregated table.
[Yes]
A7. Was the scientific quality of the included studies assessed and documented?
Quotes: None relevant.
Reasoning: No mention of assessing study quality or risk of bias.
[No]
A8. Was the scientific quality of the included studies used appropriately in formulating conclusions?
[NA] - Quality assessment was not performed (A7).
A9. Were the methods used to combine the findings of studies appropriate?
Quotes: "The statistical analysis was performed using Microsoft Office Excel and SPSS 18.0 for Windows (SPSS Corp., Chicago, IL, USA). All available data were analyzed and the quantitative data have been presented in a descriptive manner as mean and range values, except for length of follow-up where median and range values were indicated."
Reasoning: Appropriate descriptive statistics were used to summarize the findings, but no meta-analysis was performed.
[NA]
A10. Was the likelihood of publication bias assessed?
[NA] - No meta-analysis was performed.
A11. Was the conflict of interest included?
Quotes: "Conflict of interest: None."
Reasoning: Conflicts of interest for the systematic review were reported, but not for the individual included studies.
[No]
P1. Title
Quotes: "Comparison of LILT and STEP procedures in children with short bowel syndrome — A systematic review of the literature"
Reasoning: The title identifies the article as a systematic review.
[Yes]
P2. Abstract / Structured summary
Quotes: The abstract is structured with labeled sections for Purpose, Methods, Results, and Conclusions.
Reasoning: A structured abstract with the required sections is provided.
[Yes]
P3. Introduction / Rationale
Quotes: "Short bowel syndrome (SBS) is a serious disorder in which the intestinal resorptive capacity is insufficient to provide an adequate alimentary supply [1]. The estimated incidence in children is 24.5 per 100,000 live births with a higher incidence reported in preterm infants [2]. The estimated mortality is 2/100,000 population/year for children with SBS under 4 years [2] and 37.5% of neonates with SBS [3]. SBS in children occurs after congenital or acquired loss of part of the intestine [4], in most cases due to gastroschisis, necrotizing enterocolitis, mid-gut volvulus and intestinal atresia [5]."
Reasoning: Relevant background information is provided to contextualize the rationale for the review.
[Yes]
P4. Introduction / Objectives
Quotes: "Purpose: To compare LILT and STEP, the two principal procedures to lengthen the native bowel in children with a short bowel syndrome (SBS), by discussing the indications and presenting the outcome from published data."
Reasoning: The objectives are clearly stated, referencing the population, interventions, and outcomes of interest.
[Yes]
P5. Methods / Protocol and registration
Quotes: None relevant.
Reasoning: No mention of a review protocol or registration.
[No]
P6. Methods / Eligibility criteria
Quotes: "Population: Studies of humans aged 0–18 years. Intervention: Bianchi and STEP procedure, either alone or in combination. Type of study: All study designs were eligible for inclusion. Case series with 1 or more cases were included."
Reasoning: Eligibility criteria for population, interventions, and study designs were provided.
[Yes]
P7. Methods / Information sources
Quotes: "A systematic literature search was carried out using the search terms "bowel lengthening", "intestinal lengthening", "longitudinal intestinal lengthening and tailoring", "LILT", "Bianchi procedure", "serial transverse enteroplasty" and "step procedure". The last search was done on December, 10th, 2012. The reference lists of retrieved relevant articles were also cross-screened for additional studies."
Reasoning: Databases were searched up to a specified date and reference lists were screened.
[Yes]
P8. Methods / Search
Quotes: None relevant.
Reasoning: The full search strategy is not provided for any of the databases.
[No]
P9. Methods / Study selection
Quotes: "One reviewer (GF) screened all titles and abstracts to assess whether each report was potentially eligible for inclusion and whether or not the full text was available. Then, the relevant full text articles of all studies, which were considered as appropriate ones, were reviewed by one researcher (GF) who evaluated the articles and extracted their data. Afterwards, two other reviewers checked the data extraction of studies to estimate reliability (SW and AN). Any disagreement during study selection and data extraction process was resolved by discussion between first author (GF) and senior authors (AM, SHC)."
Reasoning: The study selection process is described, involving screening of titles/abstracts, full-text review, and resolution of disagreements.
[Yes]
P10. Methods / Data collection process
Quotes: "One reviewer (GF) screened all titles and abstracts to assess whether each report was potentially eligible for inclusion and whether or not the full text was available. Then, the relevant full text articles of all studies, which were considered as appropriate ones, were reviewed by one researcher (GF) who evaluated the articles and extracted their data. Afterwards, two other reviewers checked the data extraction of studies to estimate reliability (SW and AN). Any disagreement during study selection and data extraction process was resolved by discussion between first author (GF) and senior authors (AM, SHC)."
Reasoning: The data extraction process is described, involving one researcher extracting data and two others checking for reliability.
[Yes]
P11. Methods / Data items
Quotes: None relevant.
Reasoning: The specific data items collected are not defined.
[No]
P12. Methods / Risk of bias in individual studies
Quotes: None relevant.
Reasoning: No risk of bias assessment was described.
[No]
P13. Methods / Summary measures
Quotes: "The statistical analysis was performed using Microsoft Office Excel and SPSS 18.0 for Windows (SPSS Corp., Chicago, IL, USA). All available data were analyzed and the quantitative data have been presented in a descriptive manner as mean and range values, except for length of follow-up where median and range values were indicated."
Reasoning: Summary measures (means, medians, ranges) are specified.
[Yes]
P14. Methods / Synthesis of results
[NA] - No meta-analysis was performed.
P15. Methods / Risk of bias across studies
[NA] - No meta-analysis was performed.
P16. Methods / Additional analyses
[NA] - No meta-analysis was performed.
P17. Results / Study selection
Quotes: "Fig. 2 Screening design and summarized number of screened reports with identified relevant and useable articles during the review process, using the modified flow chart according to the QUOROM statement by Moher et al. [10]."
Reasoning: A flow diagram of the study selection process with numbers at each stage is provided.
[Yes]
P18. Results / Study characteristics
Quotes: "Table 1 List of evaluated and reviewed STEP (n = 109) and LILT (n = 363) procedures in published case reports from 1991 to 2012."
Reasoning: Study characteristics are provided in an aggregated table with citations.
[Yes]
P19. Results / Risk of bias within studies
[NA] - No risk of bias assessment was performed (P12).
P20. Results / Results of individual studies
Quotes: None relevant.
Reasoning: Results for individual studies are not provided, only aggregated results.
[No]
P21. Results / Synthesis of results
[NA] - No meta-analysis was performed.
P22. Results / Risk of bias across studies
[NA] - No meta-analysis was performed.
P23. Results / Additional analysis
[NA] - No meta-analysis was performed.
P24. Discussion / Summary of evidence
Quotes: "The first pivotal aim in the therapy of SBS is to ensure alimentation of the child by parenteral nutrition (PN), which results in significant improvements in mortality rates and improved thrive and quality of life in paediatric SBS [65,66]. Nevertheless, the long-term application of parenteral nutrition is associated with multiple complications, primarily significant liver dysfunction. While first-line therapy is always conservative, surgery should be taken into account in cases of failed intestinal adaptation. LILT and STEP are both accepted procedures potentially able to wean the child from PN, therefore promoting intestinal autonomy and patient outcome."
Reasoning: The main findings are summarized with consideration of their relevance to key stakeholders.
[Yes]
P25. Discussion / Limitations
Quotes: "From literature data neither procedure seems to have an advantage over the other in this regard."
Reasoning: Some limitations are briefly mentioned, but not discussed in detail at the study and review levels.
[No]
P26. Discussion / Conclusions
Quotes: "Therefore, LILT and STEP are complementary and supportive to further therapeutic approaches. In comparison with SBTX, both procedures have less associated complications and are independent of the availability of donor organs [67]. The choice for one of both surgical options is essentially driven by feasibility of the procedures and the associated outcome. From the technical perspective STEP has many clear advantages over LILT (Table 4), as during STEP procedure the manipulation and dissection of the mesentery and vasculature are not necessary, which reduces the chance of vascular compromises in comparison with LILT [59]. STEP can be applied to reduce varying degrees of bowel dilatation and may be performed on short and asymmetrical segments of dilated bowel [36,60], which is not feasible with LILT. In intricate intestinal segments, such as the duodenum and adjacent jejunum, only STEP is feasible [34,38]."
Reasoning: The conclusions provide an interpretation of the results in the context of other evidence and implications for practice.
[Yes]
P27. Funding
Quotes: "Acknowledgments: The authors are very grateful to "Heidelberger Stiftung Chirurgie" for supporting this publication."
Reasoning: Sources of funding for the systematic review are described.
[Yes]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
1
|
0
|
1
|
0
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
1
|
0
|
1
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
0
|
NA
|
1
|
1
|
0
|
1
|
1
|
0
|
NA
|
1
|
0
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
NA
|
NA
|
0
|
1
|
0
|
1
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
1
|
0
|
0
|
1
|
0
|
0
|
1
|
0
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
0
|
1
|
0
|
0
|
1
|
0
|
NA
|
1
|
NA
|
0
|
LLM response
19 quote(s) from
publication full text (mean similarity 98.7%)
A1. Was an 'a priori' design provided?
Quotes: None relevant
Reasoning: The article does not mention a protocol, ethics approval, or pre-determined research objectives.
[No]
A2. Was there duplicate study selection and data extraction?
Quotes: "Data about postoperative mortality and morbidity were given in 14 studies with a total of 470 patients (264 LGEA): 344 (73%) patients underwent CI, 99 (21%) children underwent GPU, and 27 (6%) patients underwent JI."
Reasoning: The data extraction process is described, but there is no mention of it being done in duplicate.
[No]
A3. Was a comprehensive literature search performed?
Quotes: "A literature search (PubMed and Embase) was performed, and all human studies published in the English-language literature between 2006 and 2011 describing esophageal replacement for LGEA were identified, using the medical subject headings "Esophageal Atresia," "Long-gap," "Esophagoplasty," "Replacement," "Interposition," "Substitution," "Graft," and their combinations. All titles and abstracts were scanned and appropriate citations were reviewed. Also, a manual search of the bibliographies of relevant articles was done to identify publications for possible inclusion. Included were prospective, retrospective, and comparative studies."
Reasoning: At least 2 databases were searched and supplemented by scanning reference lists of included studies.
[Yes]
A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion?
Quotes: None relevant
Reasoning: The inclusion criteria do not mention including grey literature or unpublished studies.
[No]
A5. Was a list of studies (included and excluded) provided?
Quotes: "A total of 15 studies (4 comparative retrospective, 8 retrospective, and 3 prospective) including 470 patients (264 LGEA) were identified; 344 (73%) patients underwent CI, 99 (21%) GPU, and 27 (6%) JI."
Reasoning: A list of included studies is provided in Table 1, but there is no list of excluded studies.
[No]
A6. Were the characteristics of the included studies provided?
Quotes: See Table 1 which provides author, year, replacement performed, number of patients, and study type for each included study.
Reasoning: Key characteristics of the included studies are provided in an aggregated table.
[Yes]
A7. Was the scientific quality of the included studies assessed and documented?
Quotes: None relevant
Reasoning: The article does not mention assessing or documenting the quality of included studies.
[No]
A8. Was the scientific quality of the included studies used appropriately in formulating conclusions?
[NA] - Question A7 was answered "No"
A9. Were the methods used to combine the findings of studies appropriate?
Quotes: "Studies were divided into the following three groups: JI, CI, and GPU. To perform the statistical overview Comprehensive Meta Analysis software (Version 2.2.064) was used. Data were computed using a random effects approach."
Reasoning: Appropriate statistical methods were used to combine the findings of the studies.
[Yes]
A10. Was the likelihood of publication bias assessed?
[NA] - This systematic review did not include a meta-analysis.
A11. Was the conflict of interest included?
Quotes: "Conflict of interest: None"
Reasoning: A statement on conflict of interest is provided for the systematic review but not for each included study.
[No]
P1. Title
Quotes: "Long-Gap Esophageal Atresia: a Meta-Analysis of Jejunal Interposition, Colon Interposition, and Gastric Pull-Up"
Reasoning: The title identifies the article as a meta-analysis.
[Yes]
P2. Abstract / Structured summary
Quotes: See the structured abstract on the first page with labeled sections for Aim, Methods, Main Results, and Conclusion.
Reasoning: The article provides a structured abstract with the required sections.
[Yes]
P3. Introduction / Rationale
Quotes: "There is still no consensus about the optimal surgical approach for esophageal replacement in the case of long-gap esophageal atresia (LGEA) or extensive corrosive strictures. This is reflected in the pediatric surgical literature, which mainly consists of retrospective case series."
Reasoning: The introduction explains the rationale for the review in the context of lack of consensus on the optimal surgical approach.
[Yes]
P4. Introduction / Objectives
Quotes: "The aim of this article was to perform a meta-analysis comparing the most widely used techniques for esophageal replacement in children: jejunal interposition (JI), colon interposition (CI), and gastric pull-up (GPU)."
Reasoning: The objective of the review is clearly stated.
[Yes]
P5. Methods / Protocol and registration
Quotes: None relevant
Reasoning: The article does not mention a protocol or registration number.
[No]
P6. Methods / Eligibility criteria
Quotes: "The articles were reviewed with a special focus on mortality, postoperative morbidity, and long-term follow-up. Main outcome parameters were postoperative survival rate, anastomotic complications (such as leakage and strictures recorded both postoperative and during the follow-up), and graft loss. Secondary outcome parameters were early respiratory complications (pneumothorax, atelectasis, mediastinitis, pleural effusion, and temporary diaphragm/vocal cord paresis), hospital stay, and intensive care unit (ICU) stay."
Reasoning: The eligibility criteria in terms of outcome parameters are specified.
[Yes]
P7. Methods / Information sources
Quotes: "A literature search (PubMed and Embase) was performed, and all human studies published in the English-language literature between 2006 and 2011 describing esophageal replacement for LGEA were identified, using the medical subject headings "Esophageal Atresia," "Long-gap," "Esophagoplasty," "Replacement," "Interposition," "Substitution," "Graft," and their combinations."
Reasoning: The information sources (PubMed and Embase) and date range are provided.
[Yes]
P8. Methods / Search
Quotes: "A literature search (PubMed and Embase) was performed, and all human studies published in the English-language literature between 2006 and 2011 describing esophageal replacement for LGEA were identified, using the medical subject headings "Esophageal Atresia," "Long-gap," "Esophagoplasty," "Replacement," "Interposition," "Substitution," "Graft," and their combinations."
Reasoning: The search terms are provided but the full search strategy is not presented.
[No]
P9. Methods / Study selection
Quotes: "All titles and abstracts were scanned and appropriate citations were reviewed. Also, a manual search of the bibliographies of relevant articles was done to identify publications for possible inclusion. Included were prospective, retrospective, and comparative studies."
Reasoning: The process of scanning titles/abstracts and reviewing full-texts is described.
[Yes]
P10. Methods / Data collection process
Quotes: None relevant
Reasoning: The data collection process is not described in detail.
[No]
P11. Methods / Data items
Quotes: "The articles were reviewed with a special focus on mortality, postoperative morbidity, and long-term follow-up. Main outcome parameters were postoperative survival rate, anastomotic complications (such as leakage and strictures recorded both postoperative and during the follow-up), and graft loss. Secondary outcome parameters were early respiratory complications (pneumothorax, atelectasis, mediastinitis, pleural effusion, and temporary diaphragm/vocal cord paresis), hospital stay, and intensive care unit (ICU) stay. Long-term follow-up data focused on gastrointestinal and respiratory outcomes, when defined."
Reasoning: The data items collected are listed.
[Yes]
P12. Methods / Risk of bias in individual studies
Quotes: None relevant
Reasoning: The article does not mention assessing risk of bias in individual studies.
[No]
P13. Methods / Summary measures
Quotes: "Mortality is similar: postoperative survival rate after CI was 96%, after GPU 90.4%. Anastomotic strictures (16.3% after CI vs 17.7% after GPU) and graft loss (4.2% after CI vs 4.8% after GPU) are comparable after these two procedures."
Reasoning: The summary measures (survival rate, stricture rate, graft loss rate) are stated.
[Yes]
P14. Methods / Synthesis of results
[NA] - This systematic review did not include a meta-analysis.
P15. Methods / Risk of bias across studies
[NA] - This systematic review did not include a meta-analysis.
P16. Methods / Additional analyses
[NA] - This systematic review did not include a meta-analysis.
P17. Results / Study selection
Quotes: "A total of 15 studies (4 comparative retrospective, 8 retrospective, and 3 prospective) including 470 patients (264 LGEA) were identified; 344 (73%) patients underwent CI, 99 (21%) GPU, and 27 (6%) JI."
Reasoning: The number of included studies and patients is provided, but there is no flow diagram or details on studies excluded at each stage.
[No]
P18. Results / Study characteristics
Quotes: See Table 1 which provides author, year, replacement performed, number of patients, and study type for each included study.
Reasoning: The characteristics of each included study are presented.
[Yes]
P19. Results / Risk of bias within studies
Quotes: None relevant
Reasoning: The results do not include an assessment of risk of bias within studies.
[No]
P20. Results / Results of individual studies
Quotes: See Tables 2a, 2b, and 2c which provide outcome data for each individual study.
Reasoning: The results for each individual study are presented for the main outcomes.
[Yes]
P21. Results / Synthesis of results
[NA] - This systematic review did not include a meta-analysis.
P22. Results / Risk of bias across studies
[NA] - This systematic review did not include a meta-analysis.
P23. Results / Additional analysis
[NA] - This systematic review did not include a meta-analysis.
P24. Discussion / Summary of evidence
Quotes: "The present article set out to perform a meta-analysis of the literature regarding esophageal replacement for LGEA or extensive corrosive strictures. The aim of this article was to perform a meta-analysis comparing the most widely used techniques for esophageal replacement in children: jejunal interposition (JI), colon interposition (CI), and gastric pull-up (GPU). Methods Review of the English-language literature published in the past 5 years about esophageal replacement in children was done. The focus was on postoperative survival rate, morbidity (gastrointestinal complications such as anastomotic stenosis/leakage and respiratory complications such as pneumothorax, pneumonia, and atelectasis), and long-term follow-up when available. Among long-term gastrointestinal outcomes were dysphagia, reflux, and dumping; among long-term respiratory outcomes were recurrent pneumonia and recurrent aspiration leading to chronic lung disease."
Reasoning: The main findings are summarized, including the strength of evidence for key outcomes.
[Yes]
P25. Discussion / Limitations
Quotes: "Far fewer studies describe the results of GPU and only two authors have illustrated their experience with JI. If all studies about esophageal replacement for LGEA were similar we could compute a simple mean of the effect sizes, but considering the above mentioned methodological heterogeneity a simple comparison of the mean of the event rates described by different investigators seems inadequate. For this reason, we used a random effects model, using a weighted analysis of the most recent studies. Therefore the data depict an estimated overall effect. One should realize that this is only an approximation of reality and that conclusions should be carefully considered. However there are some tendencies that undeniably draw attention."
Reasoning: Limitations such as the small number of studies on GPU and JI and methodological heterogeneity are discussed.
[Yes]
P26. Discussion / Conclusions
Quotes: "Importantly, there is little mortality regardless of the type of replacement. In contrast, morbidity is significant. In 470 patients, 93 early respiratory complications and 262 early gastrointestinal complications are reported. Reoperations (e.g., because of graft loss or anastomotic leaks) were necessary in 6% of patients. Reoperation was most prevalent in one of the two JI studies, mainly because of dismal results in this small series (Cauchi et al's). However, the reoperation rate of 6% probably is an underestimation, as anastomotic strictures were mentioned in 74 patients (16% of cases) and one might expect that many of these were dilated, which should be considered a reoperation."
Reasoning: The conclusions provide a general interpretation of the results in the context of the evidence.
[Yes]
P27. Funding
Quotes: None relevant
Reasoning: The article does not provide information on funding sources.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
1
|
0
|
1
|
0
|
NA
|
NA
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
0
|
1
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
1
|
1
|
0
|
NA
|
NA
|
NA
|
NA
|
1
|
0
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
NA
|
0
|
1
|
0
|
0
|
NA
|
0
|
NA
|
1
|
1
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
0
|
0
|
0
|
1
|
0
|
0
|
NA
|
NA
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
0
|
0
|
0
|
0
|
1
|
1
|
0
|
NA
|
0
|
0
|
LLM response
18 quote(s) from
publication full text (mean similarity 99%)
1
quote(s) from the LLM prompt briefing (mean similarity 100%) -
were instructions quoted (ok) or examples (unwanted beahviour)?
A1
Quote: "We performed a systematic literature review of the long-term outcome of OPEN surgery compared with L-TERPT/TERPT."
Reasoning: The research question and inclusion criteria were established before conducting the review.
[Yes]
A2
Quotes: "There should be at least two independent data extractors and a consensus procedure for disagreements should be in place. Note: 2 people do study selection, 2 people do data extraction, consensus process or one person checks the other's work."
Reasoning: The methods do not mention duplicate study selection and data extraction or a consensus procedure.
[No]
A3
Quotes: "A systematic PubMed search was performed to identify publications on outcome of children with HD, who underwent either OPEN, L-TERPT, or TERPT. This search was limited to the past 5 years (2008 to 2012) using the keywords "Hirschsprung" and "outcome." Reference lists were screened for additional studies."
Reasoning: At least two electronic databases were not searched, only PubMed was used along with reference screening.
[No]
A4
Reasoning: The inclusion of grey literature was not used as an inclusion criterion and there is no mention of including reports regardless of publication type.
[No]
A5
Quote: "Eighteen articles fulfilled the inclusion criteria and were analyzed in detail."
Reasoning: A list of included studies was not provided and excluded studies were not mentioned.
[No]
A6
Quotes: "A total of 387 patients were included in this review (range: 10 to 192 patients per study). Of these, 387 patients underwent open surgery for HD (OPEN), 481 children were operated on via L-TERPT, and 544 had a TERPT. The median number of patients in the OPEN group was n = 24 compared with n = 25 in the L-TERPT/TERPT group."
Reasoning: Aggregated data on the number of patients and surgical techniques were provided for the included studies.
[Yes]
A7
Quotes: "Only articles comprehensively describing the surgical methods (OPEN, L-TERPT, TERPT) and reporting on major outcome parameters (soiling/incontinence, constipation, enterocolitis, and/or stricture) were included in this study. Exclusion criteria were follow-up less than 12 months, cohorts smaller than 10 patients, articles in a language other than English, series of total colonic aganglionosis, and publication in nonpeer-reviewed journals."
Reasoning: The scientific quality of included studies was assessed based on described criteria for inclusion and exclusion.
[Yes]
A8
Reasoning: The results do not appear to account for the methodological rigor and scientific quality of the included studies when formulating conclusions and recommendations.
[No]
A9
Reasoning: This systematic review did not perform a meta-analysis or any pooling of study results.
[NA]
A10
Reasoning: The likelihood of publication bias was not assessed.
[No]
A11
Reasoning: The sources of funding and conflicts of interest for the systematic review and included studies were not reported.
[No]
P1
Quote: "Open Versus Transanal Pull-Through for Hirschsprung Disease: A Systematic Review of Long-Term Outcome"
Reasoning: The title identifies the article as a systematic review.
[Yes]
P2
Quote: "Abstract Introduction Various surgical techniques for the treatment of Hirschsprung disease (HD) have been proposed. The most relevant long-term complications of HD surgery include constipation, soiling/incontinence, enterocolitis, and anastomotic stricture. To date, there has been no randomized controlled trial evaluating the long-term outcome of OPEN surgery compared with transanal approaches with and without laparoscopy (laparoscopic-assisted transanal-endorectal pull-through [L-TERPT] and transanal-endorectal pull-through [TERPT]). We performed a systematic literature review of the long-term outcome of OPEN surgery compared with L-TERPT/TERPT."
Reasoning: The article provides a structured abstract summarizing the background, methods, and results.
[Yes]
P3
Quote: "Various surgical procedures for the treatment of Hirschsprung disease (HD) have been proposed. The principle of all techniques is the resection of the aganglionic segment and anastomosis."
Reasoning: The introduction describes the rationale for the review in the context of existing surgical treatments for Hirschsprung disease.
[Yes]
P4
Quote: "We performed a systematic literature review of the long-term outcome of OPEN surgery compared with L-TERPT/TERPT."
Reasoning: The introduction provides an explicit statement of the question being addressed (comparing long-term outcomes of open vs transanal pull-through surgery).
[Yes]
P5
Reasoning: The existence of a review protocol and registration information are not reported.
[No]
P6
Quotes: "Only articles comprehensively describing the surgical methods (OPEN, L-TERPT, TERPT) and reporting on major outcome parameters (soiling/incontinence, constipation, enterocolitis, and/or stricture) were included in this study. Exclusion criteria were follow-up less than 12 months, cohorts smaller than 10 patients, articles in a language other than English, series of total colonic aganglionosis, and publication in nonpeer-reviewed journals."
Reasoning: The inclusion and exclusion criteria related to study characteristics and report characteristics are specified.
[Yes]
P7
Quote: "A systematic PubMed search was performed to identify publications on outcome of children with HD, who underwent either OPEN, L-TERPT, or TERPT. This search was limited to the past 5 years (2008 to 2012) using the keywords "Hirschsprung" and "outcome." Reference lists were screened for additional studies."
Reasoning: The information sources searched are described (PubMed and reference lists) but the date last searched is not provided.
[No]
P8
Reasoning: The full search strategy is not presented for any of the databases searched.
[No]
P9
Quote: "Eighteen articles fulfilled the inclusion criteria and were analyzed in detail."
Reasoning: The number of included studies is provided but the process of screening and selecting studies is not described in detail.
[No]
P10
Reasoning: The data collection process is not described, such as whether data extraction forms were used, if it was done in duplicate, and if data was obtained or confirmed with study investigators.
[No]
P11
Reasoning: The data items sought for extraction are not defined, such as PICOS elements, funding sources, or any assumptions made.
[No]
P12
Reasoning: The methods do not describe assessing risk of bias in the individual included studies.
[No]
P13
Reasoning: The principal summary measures are not explicitly stated, such as risk ratios or mean differences.
[No]
P14
Reasoning: A meta-analysis was not performed in this systematic review.
[NA]
P15
Reasoning: Methods for assessing risk of bias that may affect the cumulative evidence, such as publication bias or selective reporting, are not specified.
[No]
P16
Reasoning: Additional analyses such as sensitivity analysis, subgroup analysis, or meta-regression were not mentioned.
[NA]
P17
Quote: "Eighteen articles fulfilled the inclusion criteria and were analyzed in detail."
Reasoning: The number of included studies is provided but a flow diagram is not included showing the numbers screened and excluded at each stage with reasons.
[No]
P18
Quotes: "A total of 387 patients were included in this review (range: 10 to 192 patients per study). Of these, 387 patients underwent open surgery for HD (OPEN), 481 children were operated on via L-TERPT, and 544 had a TERPT. The median number of patients in the OPEN group was n = 24 compared with n = 25 in the L-TERPT/TERPT group. Median age at surgery was 13 months in the OPEN group (range 3 to 42 months) compared with 7 months in the L-TERPT/TERPT group (range 2 to 30 months)."
Reasoning: Study characteristics including number of patients, surgical techniques, and age at surgery are presented for each included study.
[Yes]
P19
Reasoning: The results do not present data on the risk of bias for each included study.
[No]
P20
Reasoning: Simple summary data and effect estimates for each study are not provided for the outcomes considered.
[No]
P21
Reasoning: A meta-analysis was not performed.
[NA]
P22
Reasoning: An assessment of risk of bias across studies was not reported.
[No]
P23
Reasoning: Additional analyses were not performed.
[NA]
P24
Quote: "Functional outcome of surgical techniques for HD is highly variable. The results of the current study confirm a significant advantage of L-TERPT/TERPT over OPEN surgery in terms of soiling/incontinence and constipation. In contrast, no differences were seen for enterocolitis and anastomotic stricture."
Reasoning: The discussion summarizes the main findings including the strength of evidence for the main outcomes.
[Yes]
P25
Quote: "Although the present review of the recent literature revealed a higher incidence of constipation and soiling/incontinence after OPEN surgery compared with L-TERPT/TERPT, these data need to be carefully interpreted. The following limitations of the present analysis and validity of the data on the long-term outcome in the current literature may be discussed:"
Reasoning: Limitations of the review are discussed, such as the need to carefully interpret the data due to limitations of the current literature.
[Yes]
P26
Quote: "Prospective, randomized, multicenter trials are urgently needed to overcome this weakness of the current literature."
Reasoning: The conclusions provide implications for future research, stating the need for prospective randomized multicenter trials.
[Yes]
P27
Reasoning: Sources of funding for the systematic review and the role of funders are not described.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
0
|
0
|
1
|
1
|
0
|
0
|
0
|
NA
|
NA
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
0
|
0
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
0
|
0
|
0
|
NA
|
NA
|
NA
|
NA
|
1
|
0
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
NA
|
NA
|
1
|
1
|
0
|
0
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
1
|
0
|
0
|
0
|
1
|
1
|
NA
|
NA
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
0
|
1
|
0
|
0
|
1
|
1
|
1
|
NA
|
NA
|
0
|
LLM response
14 quote(s) from
publication full text (mean similarity 99.1%)
2
quote(s) from the LLM prompt briefing (mean similarity 100%) -
were instructions quoted (ok) or examples (unwanted beahviour)?
A1. Was an 'a priori' design provided?
"Ryerson et al. from Los Angeles retrospectively evaluated 224 patients with severe CHD over an eight year period [8]."
The review was conducted retrospectively, suggesting no a priori design was provided.
[No]
A2. Was there duplicate study selection and data extraction?
No relevant quotes found. The authors do not mention any duplicate study selection or data extraction processes.
[No]
A3. Was a comprehensive literature search performed?
"Adhering to PRISMA guidelines, a broad-based search strategy was conducted with two separate authors and librarians involved. MeSH headings and terms used are listed along with the number of citations retrieved with each search (Table 1). Included were all English language prospective studies and meta-analyses, retrospective cohort studies, large case series and comparison case series."
A broad search was conducted using MeSH terms and multiple databases. Supplementary strategies like consulting librarians were also used.
[Yes]
A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion?
No relevant quotes found. The inclusion of grey literature is not mentioned.
[No]
A5. Was a list of studies (included and excluded) provided?
No relevant quotes found. Neither included nor excluded study lists are provided in the text.
[No]
A6. Were the characteristics of the included studies provided?
"For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations."
The review provides study characteristics and citations for the included studies.
[Yes]
A7. Was the scientific quality of the included studies assessed and documented?
"The evidence was graded and the recommendations classified based on the Oxford system."
The methodological quality of included studies was assessed using the Oxford system.
[Yes]
A8. Was the scientific quality of the included studies used appropriately in formulating conclusions?
"The evidence was graded and the recommendations classified based on the Oxford system."
The graded evidence based on study quality was used to classify the recommendations.
[Yes]
A9. Were the methods used to combine the findings of studies appropriate?
No relevant quotes found. This appears to be a systematic review without a meta-analysis, so quantitative synthesis methods are not applicable.
[NA]
A10. Was the likelihood of publication bias assessed?
No relevant quotes found. Publication bias is not mentioned in the text.
[NA]
A11. Was the conflict of interest included?
No relevant quotes found. Conflicts of interest are not reported for the systematic review or the included studies.
[No]
P1. Title
"Asymptomatic malrotation: Diagnosis and surgical management An American Pediatric Surgical Association outcomes and evidence based practice committee systematic review"
The title identifies the article as a systematic review.
[Yes]
P2. Abstract / Structured summary
The abstract is structured with labeled sections including Background, Methods, Results, and Conclusions.
[Yes]
P3. Introduction / Rationale
"Malrotation, also known as intestinal rotation abnormality (IRA), can pose a great risk to the pediatric patient owing to the potential for a catastrophic event such as midgut volvulus, ischemic bowel, and possible short bowel syndrome or death [1]. In the past few decades, imaging modalities for this disorder have improved and become more commonplace. This has resulted in asymptomatic patients being diagnosed with malrotation incidentally during their workups for congenital heart disease or other anomalies [2]."
The introduction provides rationale for the review in the context of what is known about malrotation and its diagnosis.
[Yes]
P4. Introduction / Objectives
"The treatment of asymptomatic malrotation is controversial. Methods: Data were compiled from a broad search of Medline, Cochrane, Embase and Web of Science from January 1980 through January 2013 for five questions regarding asymptomatic malrotation."
The objectives are stated in terms of the questions the review aims to address.
[Yes]
P5. Methods / Protocol and registration
No relevant quotes found. A protocol or registration number is not mentioned.
[No]
P6. Methods / Eligibility criteria
"Included were all English language prospective studies and meta-analyses, retrospective cohort studies, large case series and comparison case series. Databases searched included MEDLINE (1980–April 2014), PubMed (1980–May 2014), and the Cochrane collection. We further divided the searches into those published from 1980 through the end of 1999 and those published after the year 2000."
Eligibility criteria for study designs, language, and publication dates are provided with rationale.
[Yes]
P7. Methods / Information sources
"Databases searched included MEDLINE (1980–April 2014), PubMed (1980–May 2014), and the Cochrane collection."
The databases searched and dates of coverage are described.
[Yes]
P8. Methods / Search
Table 1 provides the MeSH search terms used, though the full electronic search strategy is not presented in a way that it could be repeated.
[No]
P9. Methods / Study selection
"A total of 224 abstracts were found in a broad search strategy and screened. No prospective studies were found. Therefore, evaluation of the available literature regarding screening for malrotation included retrospective single institution case series that had no comparison groups. Historic data, selection bias, and institutional bias were noted in most studies."
The study selection process is described, from screening of abstracts to inclusion of retrospective case series.
[Yes]
P10. Methods / Data collection process
No relevant quotes found. The data collection process is not described.
[No]
P11. Methods / Data items
No relevant quotes found. Variables for which data were sought are not defined.
[No]
P12. Methods / Risk of bias in individual studies
No relevant quotes found. Assessment of risk of bias in individual studies is not mentioned.
[No]
P13. Methods / Summary measures
No relevant quotes found. Principal summary measures are not stated.
[No]
P14. Methods / Synthesis of results
Not applicable for a systematic review without meta-analysis.
[NA]
P15. Methods / Risk of bias across studies
Not applicable for a systematic review without meta-analysis.
[NA]
P16. Methods / Additional analyses
Not applicable for a systematic review without meta-analysis.
[NA]
P17. Results / Study selection
"A total of 224 abstracts were found in a broad search strategy and screened. No prospective studies were found. Therefore, evaluation of the available literature regarding screening for malrotation included retrospective single institution case series that had no comparison groups."
The number of studies screened and included is provided, though a full flow diagram is not included.
[Yes]
P18. Results / Study characteristics
Study characteristics like number of patients, age, and postop bowel obstruction are provided for each included study in Table 4.
[Yes]
P19. Results / Risk of bias within studies
No relevant quotes found. Assessment of risk of bias in individual studies is not provided.
[No]
P20. Results / Results of individual studies
"For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot."
Simple summary data is provided for each study in Table 4, but effect estimates and confidence intervals are not reported.
[No]
P21. Results / Synthesis of results
Not applicable for a systematic review without meta-analysis.
[NA]
P22. Results / Risk of bias across studies
Not applicable for a systematic review without meta-analysis.
[NA]
P23. Results / Additional analysis
Not applicable for a systematic review without meta-analysis.
[NA]
P24. Discussion / Summary of evidence
"The present review revealed a paucity of prospective studies evaluating patients with malrotation, and in particular, patients with congenital heart disease and intestinal rotation abnormalities."
The main findings are summarized, considering their relevance to the population of interest.
[Yes]
P25. Discussion / Limitations
"Historic data, selection bias, and institutional bias were noted in most studies."
Limitations at the study level are discussed.
[Yes]
P26. Discussion / Conclusions
"We recommend that each major institution evaluates their current approach to patients with asymptomatic malrotation and creates a consistent plan of management that can be studied and revised as needed. Our review would support the following management algorithm: When a patient is diagnosed with malrotation as a result of a screening study, particularly on another study considering should be given to three factors: 1) presence of symptoms, 2) status of cardiac disease, and 3) age. All patients need to undergo an UGI to confirm the diagnosis. At that point an attempt should be made to further define the anatomy as to whether the patient has true malrotation with a narrow mesenteric stalk, nonrotation with a broad mesentery or patient anatomy with malposition of the duodenum. Patients who are symptomatic should undergo a diagnostic laparoscopy and Ladd procedure but in "normal" anatomy is confirmed. True malrotation may be considered abnormal. Nonrotation and atypical anatomy with duodenal malposition may be more difficult to reliably diagnose since there are some false positives and false negative with any radiologic studies."
A general interpretation of the results is provided in the context of other evidence, with implications for future practice.
[Yes]
P27. Funding
No relevant quotes found. Sources of funding are not described.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
1
|
NA
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
1
|
0
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
0
|
1
|
1
|
0
|
1
|
1
|
0
|
0
|
1
|
1
|
1
|
1
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
1
|
0
|
0
|
0
|
1
|
1
|
1
|
1
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
0
|
1
|
0
|
0
|
1
|
1
|
1
|
1
|
0
|
0
|
LLM response
27 quote(s) from
publication full text (mean similarity 98.5%)
A1
Quote: "All published articles until August 31, 2010 were searched with the terms "laparoscopic orchiopexy", "open orchiopexy", and "children" from Medline (using PubMed as the search engine), Embase, Ovid, Web of Science, and Cochrane databases."
Reasoning: The authors specified the databases and search terms used, indicating an a priori design.
[Yes]
A2
No relevant quotes found.
Reasoning: The authors did not mention any independent screening or data extraction.
[No]
A3
Quote: "All published articles until August 31, 2010 were searched with the terms "laparoscopic orchiopexy", "open orchiopexy", and "children" from Medline (using PubMed as the search engine), Embase, Ovid, Web of Science, and Cochrane databases. No lower date limit was applied. After identifying relevant titles, the abstracts of these studies were read to decide if the study was eligible."
Reasoning: The authors searched multiple databases and provided the search terms used.
[Yes]
A4
No relevant quotes found.
Reasoning: The authors did not specify whether they searched for grey literature.
[No]
A5
Quote: "After screening 129 abstracts, 97 studies were excluded due to review article or reports in adult. The number of studies was reduced to 97 by limiting the laparoscopic management of NPT in children with the keywords "laparoscopy", "non-palpable testis", and "children"."
Reasoning: The authors provided the number of excluded studies but did not provide a list of the excluded studies.
[No]
A6
Quote: "Two hundred and twenty-six studies were initially found to report the laparoscopy in the management of NPT using the keywords "laparoscopy" and "non-palpable testis". Two hundred and three were published as complete manuscripts and 23 as abstracts."
Reasoning: The authors provided aggregate information on the included studies.
[Yes]
A7
Quote: "Each included article was appraised by three reviewers (GJ, LZL and TQS), who assessed the methodological quality of the selected studies independently. A critical review checklist of the Dutch Cochrane Centre was used to appraise the RCTs [de-Cochrane-centrum.nl, Last updated July 2010]. This checklist was also considered valid to assess the quality of non-RCTs."
Reasoning: The authors used a checklist to independently assess the methodological quality of included studies.
[Yes]
A8
Quote: "Precise localization of the undescended testis has long been considered mandatory before performing any surgical procedure [18]. Traditionally, an intra-abdominal testis has been managed through an open-groin exploration, followed by an extensive retroperitoneal dissection or laparotomy [19]."
Reasoning: The authors considered the methodological quality when formulating conclusions.
[Yes]
A9
Quote: "Statistical analyses were performed using the Review Manager 4.2.10 Software (The Cochrane Collaboration, Oxford, UK). Statistical heterogeneity was assessed using the I2 statistics. If the I2 value was less than 50%, a fixed effects meta-analysis was applied; if the I2 value was 50% or more, the random effects meta-analysis was used [16, 17]."
Reasoning: The authors used appropriate methods to combine the findings based on assessment of heterogeneity.
[Yes]
A10
No relevant quotes found.
Reasoning: The authors did not assess the likelihood of publication bias.
[No]
A11
Quote: "Conflict of interest None."
Reasoning: The authors declared no conflict of interest for the systematic review but did not report the conflicts of interest of the included studies.
[No]
P1
Quote: "Laparoscopic versus open orchiopexy for non-palpable undescended testes in children: a systemic review and meta-analysis"
Reasoning: The title identifies the article as a systematic review and meta-analysis.
[Yes]
P2
Quote: See structured abstract on page 1.
Reasoning: The article provides a structured abstract with labeled sections covering the main PRISMA elements.
[Yes]
P3
Quote: "The undescended testes (cryptorchidism) is one of the most common disorders of childhood, affecting 0.8–1.8% of infants at 1 year of age, 3% of full-term newborns, and 21% of premature babies [1, 2]. Approximate 20% of these cases represent non-palpable testes (NPT) that can be abdominal (normal or dysgenetic and high or low), intracanalicular, ectopic, or absent (true monorchia or vanishing testes) [1]. It has been established that abdominal testes may be associated with an increased risk of infertility and cancer [3, 4]."
Reasoning: The introduction describes the rationale for the review in the context of what is already known about undescended testes.
[Yes]
P4
Quote: "So far, only a few reports compared the laparoscopic and open inguinal approach in the management of NPT in children [3, 5, 9–14]. Due to the variations in patients' demography and methodologies, it is difficult to draw the conclusion regarding the benefits of laparoscopy in the treatment of NPT."
Reasoning: The introduction states the review questions and mentions the PICO elements of participants (children with NPT), interventions (laparoscopy), and comparisons (open surgery).
[Yes]
P5
No relevant quotes found.
Reasoning: The authors did not mention a protocol or registration number.
[No]
P6
Quote: "Eleven of these studies were subsequently excluded for only comparing the diagnosis of NPT, leaving 2 RCTs and 5 observational clinical studies (OCSs) for systematic review [5, 9–14] (Fig. 1). A summary of the studies' methodology, intervention characteristics, and measured outcomes was provided in Tables 1 and 2, including 176 cases of LO and 263 cases of OO."
Reasoning: The authors specified the study characteristics and report characteristics used as eligibility criteria.
[Yes]
P7
Quote: "All published articles until August 31, 2010 were searched with the terms "laparoscopic orchiopexy", "open orchiopexy", and "children" from Medline (using PubMed as the search engine), Embase, Ovid, Web of Science, and Cochrane databases. No lower date limit was applied."
Reasoning: The authors described the information sources searched and the date of last search.
[Yes]
P8
No relevant quotes found.
Reasoning: The authors did not present the full electronic search strategy for any database.
[No]
P9
Quote: "After identifying relevant titles, the abstracts of these studies were read to decide if the study was eligible. Abstracts subsequently published as articles were excluded from this group to avoid counting of results twice. The full article was retrieved when the information in the title and/or abstract appeared to meet the objective of this review."
Reasoning: The authors described the process for selecting studies.
[Yes]
P10
Quote: "Three reviewers (GJ, LZL and TQS) independently assessed selected studies, extracted data from each article with a predefined data extraction form. Data regarding the following factors were considered: first author, study duration, methodology, participant features, intervention characteristics, and outcome measures."
Reasoning: The authors described the method of data extraction.
[Yes]
P11
Quote: "Data regarding the following factors were considered: first author, study duration, methodology, participant features, intervention characteristics, and outcome measures."
Reasoning: The authors listed the data items sought.
[Yes]
P12
Quote: "Each included article was appraised by three reviewers (GJ, LZL and TQS), who assessed the methodological quality of the selected studies independently. A critical review checklist of the Dutch Cochrane Centre was used to appraise the RCTs [de-Cochrane-centrum.nl, Last updated July 2010]. This checklist was also considered valid to assess the quality of non-RCTs."
Reasoning: The authors described the methods used to assess risk of bias in the individual studies.
[Yes]
P13
Quote: "Weighted mean differences (WMDs) and ORs were used for the continuous and dichotomous outcome variables, respectively."
Reasoning: The authors stated the principal summary measures.
[Yes]
P14
Quote: "Statistical analyses were performed using the Review Manager 4.2.10 Software (The Cochrane Collaboration, Oxford, UK). Statistical heterogeneity was assessed using the I2 statistics. If the I2 value was less than 50%, a fixed effects meta-analysis was applied; if the I2 value was 50% or more, the random effects meta-analysis was used [16, 17]."
Reasoning: The authors described the methods of handling data and combining results, including measures of consistency.
[Yes]
P15
No relevant quotes found.
Reasoning: The authors did not mention any assessment of risk of bias that may affect the cumulative evidence, such as publication bias or selective reporting.
[No]
P16
No relevant quotes found.
Reasoning: The authors did not describe any additional analyses.
[No]
P17
Quote: See Figure 1 flow diagram.
Reasoning: The authors provided a flow diagram with the numbers of studies screened, assessed for eligibility, and included.
[Yes]
P18
Quote: See Tables 1 and 2.
Reasoning: The authors presented the characteristics of the included studies in table format with citations.
[Yes]
P19
Quote: "Each included article was appraised by three reviewers (GJ, LZL and TQS), who assessed the methodological quality of the selected studies independently."
Reasoning: The authors assessed the risk of bias but did not present the detailed results for each study.
[No]
P20
Quote: See Figures 2 and 3.
Reasoning: The authors presented the results for each study with summary data and effect estimates with confidence intervals in forest plots.
[Yes]
P21
Quote: See Figures 2 and 3.
Reasoning: The authors presented the results of each meta-analysis with confidence intervals and measures of consistency.
[Yes]
P22
No relevant quotes found.
Reasoning: The authors did not present any assessment of risk of bias across studies.
[No]
P23
No relevant quotes found.
Reasoning: The authors did not report any additional analyses.
[No]
P24
Quote: "In this meta-analysis, we demonstrate that the operative time, time to resume feeding and full activity is similar between LO and OO. Although the hospital stay of LO was slightly shorter than that of OO, this benefit may be less significant due to the one day basis of both procedures in most centers. In addition, the recurrence, success rate and testicular atrophy were found to be comparable between LO and LO, suggesting that laparoscopy does not provide significant advantage over open surgery for treating NPT."
Reasoning: The authors summarized the main findings and their relevance to key groups.
[Yes]
P25
Quote: "Another study indicated the longer operative and anesthesia time in laparoscopic cases, due to the natural tendency that peeping testicle is considered as located in the inguinal canal during open procedure and as intra-abdominal under a laparoscope [3]. The overall rate of abdominal testes in 3 large open surgery series is approximately 40%, and there is a higher percent of absent testes in the laparoscopic series [25–27]. However, Ferro et al. [3] reported that the percentage of abdominal testes is same in laparoscopic and open surgical approaches, with a slight difference in the incidence of inguinal and absent testes."
Reasoning: The authors discussed some limitations at the study and outcome level.
[Yes]
P26
Quote: "Extensive mobilization of the spermatic vessels and the vas is one of the advantages of laparoscopy, which is very important for a successful orchiopexy [14, 31]. Conventional inguinal orchidopexy may not achieve adequate length of testicular vessels despite extensive retroperitoneal dissection and division of inferior epigastric vessels [31]. A literature review based on 64 articles containing 8,425 undescended testicles showed unsatisfactory success rates by the open procedure for intra-abdominal testes: 67% for Fowler–Stevens, 77% for staged Fowler–Stevens, 81% for transabdominal, and 84% for intravascular orchidopexy [19]. In contrast, the success rate of laparoscopic orchiopexy (either primary or staged orchopexy) for management of abdominal NPT was reported to be greater than 90% [32–37]. Abolyosr et al. [9] reported a very similar overall success rate between OO and LO in children with peeping testes. It has been believed that compared with OO, LO may have some advantages in children with high intra-abdominal testes, because the conventional open orchidopexy may not achieve an adequate length of testicular vessels [19]. In this meta-analysis, we found no significant difference in the overall success rate and recurrence between the LO and OO groups, and the success rates were well in the range of previous studies [9, 19, 28, 38]. Combined with the fact that the total operative cost was significantly higher when laparoscopy was performed, these results may suggest that the advantages of laparoscopy could be achieved by open surgery, with a favorable cost benefit ratio. However, we noted that earlier studies reported the unnecessary open surgery following diagnostic laparoscopy [5, 10, 12]. Better conclusion can be drawn until a series of RCTs are undertaken to compare the complete LO and OO."
Reasoning: The authors provided a general interpretation of the results in the context of other evidence and implications for future research.
[Yes]
P27
Quote: "Acknowledgment This work was supported by the National Natural Science Foundation of China (No. 30200284, No. 30600478, No. 30772359, No. 81071997, No. 81072073), Program for New Century Excellent Talents in University (NCET-06-0641), Scientific Research Foundation for the Returned Overseas Chinese Scholars (2008-889), and Fundamental Research Funds for the Central Universities (201010025)."
Reasoning: The authors described the sources of funding for the systematic review.
[Yes]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
0
|
0
|
0
|
1
|
0
|
1
|
0
|
NA
|
NA
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
0
|
0
|
0
|
0
|
0
|
1
|
1
|
0
|
0
|
NA
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
0
|
0
|
0
|
NA
|
NA
|
NA
|
NA
|
1
|
0
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
NA
|
NA
|
0
|
0
|
0
|
NA
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
0
|
0
|
0
|
1
|
0
|
0
|
NA
|
NA
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
1
|
0
|
0
|
0
|
0
|
0
|
NA
|
NA
|
NA
|
0
|
LLM response
16 quote(s) from
publication full text (mean similarity 97.1%)
A1
Quote: "We systematically reviewed the pediatric literature."
Reasoning: The research question and inclusion criteria were not explicitly established before conducting the review.
[No]
A2
Quotes: "Incidences of recurrent appendicitis, complications after IA, and carcinoid tumor were estimated accounting for interstudy heterogeneity. Cost and length of stay of IA were analyzed."
"Data relating to the risk of recurrence of appendicitis, morbidity of IA, unexpected histopathologic findings after IA, and cost were extracted independently by 2 reviewers."
Reasoning: Study selection and data extraction were performed in duplicate.
[Yes]
A3
Quotes: "A Medline search was performed using the keywords appendix mass, interval appendicectomy, and children from January 1964 to July 2009 to identify reports of successful nonoperative treatment of AM in children (<16 years)."
"The reference lists of reports were also searched for relevant articles. Titles, abstracts, and full text reports were analyzed."
Reasoning: Only one database (Medline) was searched, but reference lists were also checked. Search terms were provided but the full search strategy was not.
[No]
A4
Reasoning: The inclusion of grey literature was not specified.
[No]
A5
Reasoning: A list of included studies was not provided. Excluded studies were not mentioned.
[No]
A6
Quote: "Data relating to the risk of recurrence of appendicitis, morbidity of IA, unexpected histopathologic findings after IA, and cost were extracted independently by 2 reviewers."
Reasoning: Some characteristics of included studies were provided in an aggregated form, but details on participants, interventions and outcomes for each study were lacking.
[No]
A7
Reasoning: The scientific quality of included studies was not assessed.
[No]
A8
Reasoning: Not applicable as the scientific quality of included studies was not assessed.
[NA]
A9
Reasoning: Heterogeneity was accounted for in the analysis. However, this item is not applicable as no meta-analysis was performed.
[NA]
A10
Reasoning: Publication bias was not assessed. However, this item is not applicable as no meta-analysis was performed.
[NA]
A11
Reasoning: Sources of support for the systematic review and included studies were not reported.
[No]
P1
Quote: "Is interval appendicectomy justified after successful nonoperative treatment of an appendix mass in children? A systematic review"
Reasoning: The title identifies the article as a systematic review.
[Yes]
P2
Quote: See structured abstract on first page.
Reasoning: A structured abstract with labeled sections is provided.
[Yes]
P3
Quote: "Inflammation in acute appendicitis may be enclosed by the omentum and adjacent loops of bowel, resulting in the formation of an inflammatory mass known as an appendix mass (AM). A recent meta-analysis estimated that approximately 9% of all children with acute appendicitis have an inflammatory mass at presentation [1]."
Reasoning: The rationale for the review is described in the context of what is already known.
[Yes]
P4
Quote: "The purpose of this systematic review was to evaluate the evidence for IA in children after successful nonoperative treatment of an AM based on the current available literature."
Reasoning: The review question is stated but does not explicitly reference the PICOS elements.
[No]
P5
Reasoning: The existence of a review protocol is not mentioned.
[No]
P6
Reasoning: Study characteristics and report characteristics used as eligibility criteria are not specified.
[No]
P7
Quote: "A Medline search was performed using the keywords appendix mass, interval appendicectomy, and children from January 1964 to July 2009 to identify reports of successful nonoperative treatment of AM in children (<16 years). Furthermore, the index of all issues of the Journal of Pediatric Surgery, Pediatric Surgery International, and the European Journal of Pediatric Surgery was searched for relevant articles. The reference lists of reports were also searched for relevant articles."
Reasoning: The information sources searched are described, but the date last searched is not provided for all sources.
[No]
P8
Reasoning: The full search strategy is not presented for any of the databases.
[No]
P9
Quote: "Titles, abstracts, and full text reports were analyzed. Only reports comparing IA with nonoperative expectant management in children after successful nonoperative treatment of an AM were initially filtered."
Reasoning: The study selection process is described.
[Yes]
P10
Quote: "Data relating to the risk of recurrence of appendicitis, morbidity of IA, unexpected histopathologic findings after IA, and cost were extracted independently by 2 reviewers."
Reasoning: The data extraction process is described, including the number of reviewers.
[Yes]
P11
Reasoning: The data items for which data were sought are not clearly defined.
[No]
P12
Reasoning: Methods for assessing risk of bias in individual studies are not described.
[No]
P13
Reasoning: The principal summary measures are not explicitly stated. However, this item is not applicable as no meta-analysis was performed.
[NA]
P14
Reasoning: Not applicable as no meta-analysis was performed.
[NA]
P15
Reasoning: Assessment of risk of bias across studies is not mentioned. However, this item is not applicable as no meta-analysis was performed.
[NA]
P16
Reasoning: Additional analyses are not described. However, this item is not applicable as no meta-analysis was performed.
[NA]
P17
Quote: "Twenty-three studies reported outcome after IA. All but 1 [9] were retrospective reviews. Seventeen studies reported histopathologic findings of IA specimens, and 12 reported data relating to the risk of recurrence of appendicitis, morbidity of IA, unexpected histopathologic findings after IA, and cost were extracted independently by 2 reviewers."
Reasoning: The number of studies screened, assessed for eligibility, and included is not fully reported, and a flow diagram is not provided.
[No]
P18
Reasoning: Characteristics of individual studies are not presented.
[No]
P19
Reasoning: Risk of bias of individual studies is not reported.
[No]
P20
Reasoning: Results for each study are not reported individually. However, this item is not applicable as no meta-analysis was performed.
[NA]
P21
Reasoning: Not applicable as no meta-analysis was performed.
[NA]
P22
Reasoning: Not applicable as no meta-analysis was performed.
[NA]
P23
Reasoning: Not applicable as no meta-analysis was performed.
[NA]
P24
Quote: "The most significant finding of this review is that, despite the relative frequency of the condition, we have been unable to identify any data comparing routine IA with a "watchful waiting" approach nor any prospective data relating to the risk of recurrent appendicitis in children. This mirrors other areas within pediatric surgery and highlights the need for quality prospective studies to provide the evidence required to inform and support our current practice."
Reasoning: The main findings are summarized, including their relevance to key groups.
[Yes]
P25
Quote: "Although these data suggest that hospital stay in the region of 3 days would be required, we acknowledge that, with current surgical practice of laparoscopic IA, this may be an overestimate [10,12]. The alternative watchful waiting approach carries a 1 in 5 risk of developing recurrent appendicitis and a very small risk (<1%) of missing a carcinoid tumor."
Reasoning: Some limitations at the review level are discussed.
[Yes]
P26
Quote: "When considering whether to perform an IA or not, the surgeon, parents, and, in some cases, the child are faced with choosing between the 2 approaches. The approach of performing an IA carries the benefit of removing the risk of recurrent appendicitis but at the cost of a hospital admission for a surgical procedure with a risk of complications. The alternative watchful waiting approach avoids an IA but carries with it a risk of recurrent appendicitis, requiring hospital treatment and likely an emergency operation, and, if this does not occur, then a risk of there being an underlying diagnosis, which has not been identified. Both approaches carry a cost implication. Once accurate data relating to each aspect of these 2 approaches are known, only then can a truly informed decision be made by surgeon and parents alike."
Reasoning: A general interpretation of the results is provided, along with implications for future research.
[Yes]
P27
Reasoning: Sources of funding for the systematic review are not described.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
1
|
0
|
0
|
0
|
NA
|
NA
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
0
|
0
|
0
|
0
|
0
|
1
|
0
|
0
|
0
|
0
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
1
|
1
|
0
|
NA
|
NA
|
NA
|
NA
|
1
|
0
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
NA
|
NA
|
1
|
1
|
0
|
0
|
NA
|
NA
|
NA
|
1
|
0
|
0
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
0
|
0
|
0
|
1
|
0
|
0
|
NA
|
NA
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
0
|
1
|
0
|
0
|
1
|
0
|
0
|
NA
|
NA
|
0
|
LLM response
17 quote(s) from
publication full text (mean similarity 100%)
A1
Quotes: "The study aims to address the multiple questions that must be considered regarding the safe performance of pediatric IA."
Reasoning: The research objectives were established before conducting the review.
[Yes]
A2
Quotes: No relevant quotes identified.
Reasoning: The authors did not mention duplicate study selection and data extraction.
[No]
A3
Quotes: "In December 2014, a comprehensive literature search was performed using Ovid MEDLINE (1946–present) and Embase (1974–present) using the OvidSP interfaces."
Reasoning: At least two electronic databases were searched.
[Yes]
A4
Quotes: No relevant quotes identified.
Reasoning: The authors did not specify that they searched for reports regardless of publication type.
[No]
A5
Quotes: No relevant quotes identified.
Reasoning: A list of included and excluded studies was not provided.
[No]
A6
Quotes: "Table 1 Reviewed Studies relating to incidental appendectomy (IA) performed in adult patients", "Table 2 Reviewed studies relating to incidental appendectomy (IA) performed in OB/GYN patients", "Table 3 Reviewed studies relating to incidental appendectomy (IA) performed in pediatric patients"
Reasoning: Characteristics of the included studies were provided in table format.
[Yes]
A7
Quotes: No relevant quotes identified.
Reasoning: The scientific quality of the included studies was not assessed.
[No]
A8
Quotes: No relevant quotes identified.
Reasoning: The scientific quality was not used in formulating conclusions, as it was not assessed.
[No]
A9
Quotes: No relevant quotes identified.
Reasoning: The methods for combining study findings were not described, as no meta-analysis was performed.
[NA]
A10
Quotes: No relevant quotes identified.
Reasoning: The likelihood of publication bias was not assessed.
[NA]
A11
Quotes: "Conflict of interest The authors declare that they have no conflict of interest."
Reasoning: Conflicts of interest for the systematic review were reported, but not for the individual studies.
[No]
P1
Quotes: "Pediatric incidental appendectomy: a systematic review"
Reasoning: The title identifies the article as a systematic review.
[Yes]
P2
Quotes: The abstract contains labeled sections for background, objectives, data sources, study eligibility criteria, study appraisal and synthesis methods, results, limitations, and conclusions.
Reasoning: A structured abstract with the required sections is provided.
[Yes]
P3
Quotes: "Incidental appendectomy (IA) is defined as the removal of the vermiform appendix accompanying another operation, without evidence of acute appendicitis. Advocates for IA cite ease of resection, low morbidity, no additional anesthetic risks, high incidence of disease in specimens, and elimination of confusion over future conflicting diagnosis [1]."
Reasoning: The rationale for the review is described in the context of what is already known.
[Yes]
P4
Quotes: "The study aims to address the multiple questions that must be considered regarding the safe performance of pediatric IA."
Reasoning: The objectives are provided but do not explicitly reference PICOS.
[No]
P5
Quotes: No relevant quotes identified.
Reasoning: The existence of a review protocol is not mentioned.
[No]
P6
Quotes: No relevant quotes identified.
Reasoning: Study characteristics and report characteristics used as criteria for eligibility are not specified.
[No]
P7
Quotes: "In December 2014, a comprehensive literature search was performed using Ovid MEDLINE (1946–present) and Embase (1974–present) using the OvidSP interfaces."
Reasoning: Electronic databases searched are described but the date last searched is not provided.
[No]
P8
Quotes: No relevant quotes identified.
Reasoning: The full electronic search strategy is not presented.
[No]
P9
Quotes: "Fig. 1 Preferred reporting items for systematic reviews and meta-analyses (PRISMA) flow diagram detailing the process of identification, screening, determining eligibility, and ultimate inclusion of manuscripts pertaining to incidental appendectomy in this review"
Reasoning: A PRISMA flow diagram illustrating the study selection process is provided.
[Yes]
P10
Quotes: No relevant quotes identified.
Reasoning: The method of data extraction is not described.
[No]
P11
Quotes: No relevant quotes identified.
Reasoning: Data items for which data were sought are not defined.
[No]
P12
Quotes: No relevant quotes identified.
Reasoning: The methods for assessing risk of bias of individual studies are not described.
[No]
P13
Quotes: No relevant quotes identified.
Reasoning: The principal summary measures are not stated.
[No]
P14
Quotes: No relevant quotes identified.
Reasoning: The methods of handling data and combining results are not described, as no meta-analysis was performed.
[NA]
P15
Quotes: No relevant quotes identified.
Reasoning: Assessment of risk of bias that may affect the cumulative evidence is not mentioned.
[NA]
P16
Quotes: No relevant quotes identified.
Reasoning: Additional analyses such as sensitivity analysis or meta-regression are not described.
[NA]
P17
Quotes: "Fig. 1 Preferred reporting items for systematic reviews and meta-analyses (PRISMA) flow diagram detailing the process of identification, screening, determining eligibility, and ultimate inclusion of manuscripts pertaining to incidental appendectomy in this review"
Reasoning: A PRISMA flow diagram gives the numbers of studies screened, assessed for eligibility, and included.
[Yes]
P18
Quotes: "Table 1 Reviewed Studies relating to incidental appendectomy (IA) performed in adult patients", "Table 2 Reviewed studies relating to incidental appendectomy (IA) performed in OB/GYN patients", "Table 3 Reviewed studies relating to incidental appendectomy (IA) performed in pediatric patients"
Reasoning: Characteristics of included studies are presented in table format with citations.
[Yes]
P19
Quotes: No relevant quotes identified.
Reasoning: Data on risk of bias of each study is not presented.
[No]
P20
Quotes: No relevant quotes identified.
Reasoning: Results for individual studies are not provided.
[No]
P21
Quotes: No relevant quotes identified.
Reasoning: Results of each meta-analysis are not presented, as no meta-analysis was performed.
[NA]
P22
Quotes: No relevant quotes identified.
Reasoning: Results of risk of bias across studies are not presented.
[NA]
P23
Quotes: No relevant quotes identified.
Reasoning: Results of additional analyses are not provided, as no additional analyses were described.
[NA]
P24
Quotes: "With the development of useful applications for the appendix, and given the disease-specific concerns above, thoughtful consideration should be given to the individual pediatric patient's co-morbid conditions before performing IA (Table 4)."
Reasoning: The main findings are summarized with consideration of their relevance to key groups.
[Yes]
P25
Quotes: No relevant quotes identified.
Reasoning: Limitations at the study, outcome, and review level are not discussed.
[No]
P26
Quotes: "Conclusion With the development of useful applications for the appendix, and given the disease-specific concerns above, thoughtful consideration should be given to the individual pediatric patient's co-morbid conditions before performing IA (Table 4)."
Reasoning: A general interpretation of the results is provided, but implications for future research are not discussed.
[No]
P27
Quotes: "Conflict of interest The authors declare that they have no conflict of interest."
Reasoning: Sources of funding for the systematic review are not described, only that the authors have no conflicts of interest.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
0
|
0
|
1
|
1
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
NA
|
NA
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
NA
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
0
|
0
|
0
|
NA
|
NA
|
NA
|
NA
|
0
|
0
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
NA
|
NA
|
0
|
0
|
0
|
0
|
NA
|
NA
|
NA
|
1
|
0
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
NA
|
NA
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
0
|
0
|
0
|
0
|
0
|
0
|
NA
|
NA
|
NA
|
0
|
LLM response
6 quote(s) from
publication full text (mean similarity 100%)
A1
"The authors conducted a systematic review of the pediatric and adult literature about MIA, focusing on the technique and indications."
The authors conducted a systematic review with pre-specified objectives.
[Yes]
A2
No relevant quotes found.
The authors did not mention using at least two independent reviewers for study selection and data extraction.
[No]
A3
"The authors conducted a systematic review of the pediatric and adult literature about MIA, focusing on the technique and indications."
The authors searched the literature but did not provide details on databases, years, keywords, or supplementary strategies.
[No]
A4
No relevant quotes found.
The authors did not mention whether they included or excluded studies based on publication status (e.g. grey literature).
[No]
A5
No relevant quotes found.
The authors did not provide a list of included and excluded studies.
[No]
A6
No relevant quotes found.
The authors did not provide the characteristics of included studies in aggregate form, such as in a table.
[No]
A7
No relevant quotes found.
The authors did not mention assessing and documenting the scientific quality of included studies.
[No]
A8
[NA]
A9
[NA]
A10
[NA]
A11
No relevant quotes found.
The authors did not report the sources of funding or conflicts of interest for the included studies.
[No]
P1
"Minimally invasive adrenalectomy in children"
The title identifies the article as a review on minimally invasive adrenalectomy in children.
[Yes]
P2
"Purpose: Minimally invasive adrenalectomy (MIA) is the criterion standard for removal of small adrenal tumors in adults. The purpose of this review was to determine the place of MIA in children. Methods: The authors conducted a systematic review of the pediatric and adult literature about MIA, focusing on the technique and indications. Results: Minimally invasive adrenalectomy appears superior to open adrenalectomy for small tumors. The potential advantages of MIA are appealing for postoperative pain, risk of intestinal obstruction, and quality of scars. The most common approach is the transperitoneal lateral laparoscopy, which allows for a large working space. For small tumors or for bilateral adrenalectomy, the prone retroperitoneoscopy is a promising new technique. In children, the learning curve is an issue because the indications are rare. The most common indication is neuroblastoma without image-defined surgical risk factors. The incidence of local recurrence is low, but the follow-up is short in most cases. Conclusions: Minimally invasive adrenalectomy is promising for removal of small adrenal tumors. Long-term follow-up is required to evaluate the efficacy of MIA in neuroblastomas. Benign diseases are excellent candidates for this minimally invasive technique."
The abstract provides a structured summary including background, objectives, methods, results and conclusions.
[Yes]
P3
"Minimally invasive adrenalectomy (MIA) is considered the criterion standard for adrenal surgery in adults [1,2], where it is used for benign or malignant tumors. In children [3-7], adrenal surgery is rare and is only indicated for malignant tumors."
The introduction describes the rationale for the review in the context of what is already known about MIA in adults and children.
[Yes]
P4
"The purpose of this review was to determine the place of MIA in children."
The introduction provides an explicit statement of the review's objective, though it does not mention the full PICOS elements.
[No]
P5
No relevant quotes found.
The authors did not mention if a review protocol exists or provide registration information.
[No]
P6
No relevant quotes found.
The authors did not specify the study characteristics and report characteristics used as criteria for eligibility.
[No]
P7
No relevant quotes found.
The authors did not describe all information sources searched and the date last searched.
[No]
P8
No relevant quotes found.
The authors did not present the full electronic search strategy for at least one database.
[No]
P9
No relevant quotes found.
The authors did not state the process for selecting studies.
[No]
P10
No relevant quotes found.
The authors did not describe the method of data extraction from reports.
[No]
P11
No relevant quotes found.
The authors did not provide a list of all variables for which data were sought.
[No]
P12
No relevant quotes found.
The authors did not describe methods used for assessing risk of bias in individual studies.
[No]
P13
[NA]
P14
[NA]
P15
[NA]
P16
[NA]
P17
No relevant quotes found.
The authors did not provide a flow diagram or numbers of studies screened, assessed for eligibility, and included.
[No]
P18
No relevant quotes found.
The authors did not present characteristics and citations for each included study.
[No]
P19
No relevant quotes found.
The authors did not present data on the risk of bias of each study.
[No]
P20
No relevant quotes found.
The authors did not present results for each study with simple summary data and effect estimates.
[No]
P21
[NA]
P22
[NA]
P23
[NA]
P24
"Minimally invasive adrenalectomy is superior to OA for the removal of benign adrenal diseases (benign tumors or CAH). For malignant tumors, the use of MIA should be limited to selected cases (encapsulated tumors with favorable prognostic factors or metastatic NB). Lateral transperitoneal adrenalectomy is the easiest and safest approach, but there is a role for PRA in selected cases (bilateral adrenalectomy)."
The discussion summarizes the main findings and their relevance to key groups.
[Yes]
P25
No relevant quotes found.
The authors did not discuss the limitations of the review at the study, outcome, and review level.
[No]
P26
"Minimally invasive adrenalectomy is superior to OA for the removal of benign adrenal diseases (benign tumors or CAH). For malignant tumors, the use of MIA should be limited to selected cases (encapsulated tumors with favorable prognostic factors or metastatic NB). Lateral transperitoneal adrenalectomy is the easiest and safest approach, but there is a role for PRA in selected cases (bilateral adrenalectomy)."
The authors provided a general interpretation of the results in the context of other evidence and implications for future practice.
[Yes]
P27
No relevant quotes found.
The authors did not describe sources of funding for the systematic review and other support.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
0
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
0
|
0
|
0
|
0
|
0
|
1
|
1
|
0
|
0
|
1
|
1
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
NA
|
1
|
1
|
0
|
0
|
1
|
0
|
NA
|
1
|
1
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
0
|
0
|
0
|
1
|
0
|
0
|
1
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
0
|
0
|
0
|
0
|
0
|
0
|
NA
|
1
|
0
|
0
|
LLM response
16 quote(s) from
publication full text (mean similarity 98.8%)
1
quote(s) from the LLM prompt briefing (mean similarity 100%) -
were instructions quoted (ok) or examples (unwanted beahviour)?
A1
Quote: "Purpose: To further explore the feasibility and safety of laparoscopic pyeloplasty (LP) in children with ureteropelvic junction obstruction compared with open pyeloplasty (OP). Methods: PUBMED, Web of science and Cochrane library were searched until Oct. 2014 to find eligible studies."
Reasoning: The research question and inclusion criteria were established before conducting the review.
[Yes]
A2
No relevant quotes found.
Reasoning: The authors did not mention using at least two independent data extractors or a consensus procedure for disagreements.
[No]
A3
Quote: "PUBMED, Web of science and Cochrane library was carried out between Jan. 1966 and Oct. 2014 to identify eligible studies, using the following words: "hydronephrosis OR ureteropelvic junction obstruction OR pyeloplasty", "young OR children OR child OR kids OR pediatrics" and "laparoscopic"."
Reasoning: At least two electronic databases were searched with keywords provided, but no supplementary search strategies were mentioned.
[No]
A4
No relevant quotes found.
Reasoning: The authors did not state that they searched for reports regardless of publication type or whether any reports were excluded based on publication status or language.
[No]
A5
No relevant quotes found.
Reasoning: A list of included and excluded studies was not provided.
[No]
A6
Quote: "290 publications from all above database were retrieved after removing duplicates. Among these studies, 37 studies were finally leaved behind for full-text assessment. Detailed steps of literature search were shown in Figure 1."
Reasoning: Some characteristics of included studies were provided in aggregate form in Tables 1-3, but not the full ranges of characteristics like age, sex, disease severity, etc.
[No]
A7
Quote: "Criteria for inclusion and exclusion
Studies regardless of the sample size will be eligible for inclusion if they meet the following criteria: 1). comparative study; 2). compared standard LP with OP; 3). proved sufficient data on outcomes of interest; 4). procedures should perform in children (less than 18 years old). Besides, we only concerned standard LP; other types such as RALP and one-port LP were not under consideration."
Reasoning: The authors provided inclusion and exclusion criteria for study selection, but did not specify 'a priori' methods for assessing the scientific quality of included studies.
[No]
A8
No relevant quotes found.
Reasoning: The authors did not assess the scientific quality of included studies, so this item is not applicable.
[NA]
A9
Quote: "Considering the enormous difference of evidence level, we did not pool data from a RCT with other comparative studies. Odds ratio (OR) and its 95% confidential interval (CI) were used to assess dichotomous data, while weight mean differences (WMDs) were used to assess continuous data."
Reasoning: Appropriate methods were used to combine findings, assessing heterogeneity and using odds ratios and weighted mean differences.
[Yes]
A10
No relevant quotes found.
Reasoning: The likelihood of publication bias was not assessed.
[No]
A11
Quote: "None."
Reasoning: Conflicts of interest were not reported for the systematic review or the included studies.
[No]
P1
Quote: "An updated meta-analysis of laparoscopic versus open pyeloplasty for ureteropelvic junction obstruction in children"
Reasoning: The title identifies the article as a meta-analysis.
[Yes]
P2
Quote: "Abstract: Purpose: To further explore the feasibility and safety of laparoscopic pyeloplasty (LP) in children with ureteropelvic junction obstruction compared with open pyeloplasty (OP). Methods: PUBMED, Web of science and Cochrane library were searched until Oct. 2014 to find eligible studies. WMD, OR, RD and their 95% CIs were used to estimate the difference. Baseline such as age, gender and crossing vessel, perioperative outcomes such as length of stay, operative time, overall complications, and success rate were compared. All the meta-analyses were performed in Revman 5.2. Results: 15 comparative studies and one RCT were eligible and included in the meta-analysis. Compared with OP, LP groups might be associated with shorted length of hospital stay (WMD: -1.92, 95% CI: -2.45–1.39), reduced complications (OR: 0.71, 95% CI: 0.49-1.01) and equal success rate (RD: 0.01, 95% CI: -0.02-0.04), but prolonged operative time (WMD: 48.64, 95% CI: 31.16-66.12). Conclusion: Our findings supported that laparoscopic pyeloplasty is feasibility and safety in the treatment of UPJ obstruction in children, especially in high-volume centers with experienced experts. Considering the select bias and recall bias, more RCTs are required to further explore the efficiencies of LP."
Reasoning: A structured abstract is provided with labeled sections for background, objectives, data sources, study eligibility criteria, participants and interventions, appraisal and synthesis methods, results, limitations, and conclusions.
[Yes]
P3
Quote: "Ureteropelvic junction (UPJ) obstruction is one of the commonest causes of hydronephrosis in adults, especially in children. And to date, open pyeloplasty (OP) has still been the gold standard for operative manage, though minimally invasive surgeries such as laparoscopic pyeloplasty (LP) and robot assisted laparoscopic pyeloplasty (RALP) have increasingly been adopted in pediatric practice."
Reasoning: The rationale for the review is described in the context of what is already known about ureteropelvic junction obstruction and its surgical treatment options.
[Yes]
P4
No relevant quotes found.
Reasoning: An explicit statement of the PICOS question being addressed was not provided in the introduction.
[No]
P5
No relevant quotes found.
Reasoning: The existence of a review protocol and registration information were not reported.
[No]
P6
Quote: "Criteria for inclusion and exclusion
Studies regardless of the sample size will be eligible for inclusion if they meet the following criteria: 1). comparative study; 2). compared standard LP with OP; 3). proved sufficient data on outcomes of interest; 4). procedures should perform in children (less than 18 years old). Besides, we only concerned standard LP; other types such as RALP and one-port LP were not under consideration."
Reasoning: Study eligibility criteria were specified, but a full rationale was not provided.
[No]
P7
Quote: "PUBMED, Web of science and Cochrane library was carried out between Jan. 1966 and Oct. 2014 to identify eligible studies, using the following words: "hydronephrosis OR ureteropelvic junction obstruction OR pyeloplasty", "young OR children OR child OR kids OR pediatrics" and "laparoscopic"."
Reasoning: Electronic databases searched were described with dates of coverage, but the date last searched was not clearly stated.
[No]
P8
Quote: "PUBMED, Web of science and Cochrane library was carried out between Jan. 1966 and Oct. 2014 to identify eligible studies, using the following words: "hydronephrosis OR ureteropelvic junction obstruction OR pyeloplasty", "young OR children OR child OR kids OR pediatrics" and "laparoscopic"."
Reasoning: The full search strategy with keywords was provided for the electronic databases, but the exact search strings that could be repeated were not presented.
[No]
P9
Quote: "290 publications from all above database were retrieved after removing duplicates. Among these studies, 37 studies were finally leaved behind for full-text assessment. Detailed steps of literature search were shown in Figure 1."
Reasoning: The process for selecting studies, including screening, eligibility, and inclusion, was described and shown in a flow diagram (Figure 1).
[Yes]
P10
Quote: "Data abstraction was carried out independently by two authors (Yidong Huang, Yang Wu)"
Reasoning: The method of data extraction was described as being done independently by two authors.
[Yes]
P11
No relevant quotes found.
Reasoning: All variables for which data were sought, such as PICOS and funding sources, were not clearly defined.
[No]
P12
Quote: "Criteria for inclusion and exclusion
Studies regardless of the sample size will be eligible for inclusion if they meet the following criteria: 1). comparative study; 2). compared standard LP with OP; 3). proved sufficient data on outcomes of interest; 4). procedures should perform in children (less than 18 years old). Besides, we only concerned standard LP; other types such as RALP and one-port LP were not under consideration."
Reasoning: Inclusion criteria were provided but methods for assessing risk of bias in individual studies were not described.
[No]
P13
Quote: "Odds ratio (OR) and its 95% confidential interval (CI) were used to assess dichotomous data, while weight mean differences (WMDs) were used to assess continuous data."
Reasoning: Odds ratios and weighted mean differences were stated as the principal summary measures.
[Yes]
P14
Quote: "Considering the enormous difference of evidence level, we did not pool data from a RCT with other comparative studies. Odds ratio (OR) and its 95% confidential interval (CI) were used to assess dichotomous data, while weight mean differences (WMDs) were used to assess continuous data. Because several studies reported 100% success rate in both groups, which could hardly obtain ORs, in such case, risk difference (RD) was used to evaluate this outcome."
Reasoning: The methods of handling data and combining results were described, including assessing heterogeneity and using odds ratios, risk differences, and weighted mean differences as appropriate.
[Yes]
P15
No relevant quotes found.
Reasoning: Methods for assessing risk of bias that may affect the cumulative evidence, such as publication bias across studies, were not specified.
[No]
P16
No relevant quotes found.
Reasoning: Additional analyses such as sensitivity or subgroup analyses were not mentioned.
[NA]
P17
Quote: "290 publications from all above database were retrieved after removing duplicates. Among these studies, 37 studies were finally leaved behind for full-text assessment. Detailed steps of literature search were shown in Figure 1."
Reasoning: A flow diagram (Figure 1) was provided showing the numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage.
[Yes]
P18
Quote: "Characteristics of included studies
290 publications from all above database were retrieved after removing duplicates. Among these studies, 37 studies were finally leaved behind for full-text assessment. Detailed steps of literature search were shown in Figure 1."
Reasoning: Study characteristics for which data were extracted, such as study size, PICOS, and follow-up period, were presented for each included study in Tables 1-3, along with citations in the references section.
[Yes]
P19
No relevant quotes found.
Reasoning: Data on risk of bias assessments for each included study were not presented.
[No]
P20
Quote: "For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot."
Reasoning: Simple summary data for each intervention group and effect estimates with confidence intervals were reported for outcomes in Tables 1-3 and Figures 2-8, but not displayed in forest plots.
[No]
P21
Quote: "Considering the enormous difference of evidence level, we did not pool data from a RCT with other comparative studies. Odds ratio (OR) and its 95% confidential interval (CI) were used to assess dichotomous data, while weight mean differences (WMDs) were used to assess continuous data."
Reasoning: The results of each meta-analysis, including confidence intervals and measures of consistency, were presented in the text and figures.
[Yes]
P22
No relevant quotes found.
Reasoning: The results of assessing risk of bias across studies, such as publication bias, were not presented.
[No]
P23
No relevant quotes found.
Reasoning: Additional analyses such as sensitivity or subgroup analyses were not mentioned.
[NA]
P24
Quote: "The findings of the present meta-analysis showed that children in LP groups may benefit from shortened length of hospital stay and reduced overall complications, though the LP groups are with prolonged operative time. Besides, the success rate of LP is similar to OP. Most of the findings were consistent with the previous meta-analysis conducted by Mei et al [3] except overall complications."
Reasoning: The main findings, including the strength of evidence for each main outcome, were summarized with relevance to key groups like healthcare providers and policymakers.
[Yes]
P25
Quote: "There are several limitations which should be taken into account. Firstly, only one RCT was included in this meta-analysis and most of studies were retrospective, which may lead to select bias and recall bias. More large-scaled well-designed RCT are needed to explore the feasibility and safety of LP compared with OP. Secondly, almost all the outcomes could be influence by the experience of surgeon. To attempt a real fair comparison, all the operation should be performed by one or specified surgeons to adjust for the potential effects of learning curve. But in most study included, pyeloplasty was not carried out by the same experienced surgeon in the same surgical team. This may bias our results in a certain degree."
Reasoning: Limitations at the study and outcome level (e.g. risk of bias) and at the review level (e.g. only one RCT included) were discussed.
[Yes]
P26
Quote: "Our findings of this meta-analysis revealed that LP groups were with less length of hospital stay and lower complication rate than OP groups. Considering the similar success rate of these two approaches, the laparoscopic pyeloplasty is feasibility and safety in the treatment of UPJ obstruction in children, especially in high-volume centers with experienced experts. Considering the select bias and recall bias, more RCTs are required to further explore the efficiencies of LP."
Reasoning: A general interpretation of the results in the context of other evidence and implications for future research were provided in the conclusion.
[Yes]
P27
Quote: "Disclosure of conflict of interest
None."
Reasoning: Sources of funding for the systematic review were not described, and no conflicts of interest were declared.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
1
|
0
|
NA
|
NA
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
1
|
0
|
1
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
1
|
1
|
0
|
NA
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
0
|
1
|
0
|
0
|
0
|
NA
|
NA
|
0
|
0
|
0
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
0
|
0
|
0
|
1
|
0
|
0
|
NA
|
NA
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
0
|
0
|
0
|
0
|
0
|
0
|
NA
|
NA
|
0
|
0
|
LLM response
17 quote(s) from
publication full text (mean similarity 99.9%)
A1
Quote: "The objective of the present systematic review of the literature was to investigate the role of flexible ureteroscopy and lasertripsy (FURSL) in the management of renal calculi in the paediatric population and to look at its efficacy and safety."
Reasoning: The objective clearly states the research question and scope of the review.
[Yes]
A2
Quotes: "The studies fitting the inclusion criteria were analysed for the following: journal of publication; period of review; type of study; country of origin; population demographics (age and gender); pre-operative imaging modalities used; stone size; total stone burden and location; type of anaesthesia utilised for procedure; and type of pre- and post-operative stent use."
"The procedure-based outcomes investigated were the efficacy and safety of the procedures. The efficacy of the procedure was determined by the SFR and the requirement for any further procedures."
Reasoning: Data extraction was performed, but no mention of duplicate study selection or a consensus procedure.
[No]
A3
Quotes: "The search involved finding relevant studies from MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, CINAHL, Google Scholar and individual urological journals between January 1990 and March 2014."
"The search terms included the following: 'ureteroscopy', 'flexible ureteroscopy', 'paediatric(s)', 'paediatric(s)', 'children', 'renal', 'calculi', 'stone(s)', 'urolithiasis', 'laser', 'laser therapy' and 'lithotripsy'. These terms were combined using Boolean operators (AND, OR) to refine the search."
Reasoning: At least 2 electronic databases were searched and key terms were provided. No supplementary search strategies were mentioned.
[No]
A4
Reasoning: No mention of including grey literature or unpublished studies.
[No]
A5
Reasoning: A flow diagram (Figure 1) provides the number of included and excluded studies, but no list of the excluded studies is provided.
[No]
A6
Quote: "A total of six studies were found to fit the inclusion criteria from the literature search. These studies were published between 2008 and 2014 (Fig. 1). Three studies were published from Turkey, two were from USA and the final one was from Australia. All six studies were retrospective studies."
Reasoning: Some characteristics of the included studies are provided in aggregate form, but details on participants, interventions and outcomes are lacking.
[No]
A7
Quotes: "The inclusion criteria were for studies written in the English language, reporting upon at least five cases of paediatric patients with renal calculi who underwent management with a FURSL. The paediatric patient was defined as those under the age of 18 years old. Studies that reported upon adult patients' use of rigid ureteroscopy or ureteric calculi were excluded from the present review."
"The procedure-based outcomes investigated were the efficacy and safety of the procedures. The efficacy of the procedure was determined by the SFR and the requirement for any further procedures."
Reasoning: The inclusion criteria were used to assess study eligibility, but no formal 'a priori' methods for assessing study quality were provided.
[No]
A8
Reasoning: Not applicable as study quality was not assessed (see A7).
[NA]
A9
Reasoning: Not applicable as no meta-analysis was performed.
[NA]
A10
Reasoning: Publication bias was not assessed.
[No]
A11
Reasoning: Sources of funding and conflicts of interest were not reported for the systematic review or the included studies.
[No]
P1
Quote: "Flexible ureteroscopy and lasertripsy (FURSL) for paediatric renal calculi: Results from a systematic review"
Reasoning: The title identifies the article as a systematic review.
[Yes]
P2
Quote: See the structured abstract on the first page.
Reasoning: A structured abstract is provided with labeled sections for background, material and methods, results, and conclusion.
[Yes]
P3
Quote: "The incidence of paediatric stone disease has risen in recent years [1,2], with many factors contributing to this. Developmental abnormalities of the genitourinary system, metabolic abnormalities, and geographical location bear effect on the formation of stone disease."
Reasoning: The introduction describes the rationale for the review in the context of the increasing incidence of pediatric stone disease.
[Yes]
P4
Quote: "The objective of the present systematic review of the literature was to investigate the role of flexible ureteroscopy and lasertripsy (FURSL) in the management of renal calculi in the paediatric population and to look at its efficacy and safety."
Reasoning: An explicit objective statement is provided referencing the population, intervention and outcomes of interest.
[Yes]
P5
Reasoning: No mention of a review protocol or registration number.
[No]
P6
Quote: "The inclusion criteria were for studies written in the English language, reporting upon at least five cases of paediatric patients with renal calculi who underwent management with a FURSL. The paediatric patient was defined as those under the age of 18 years old. Studies that reported upon adult patients' use of rigid ureteroscopy or ureteric calculi were excluded from the present review."
Reasoning: The inclusion criteria specifying study and report characteristics are provided with rationale.
[Yes]
P7
Quote: "The search involved finding relevant studies from MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, CINAHL, Google Scholar and individual urological journals between January 1990 and March 2014."
Reasoning: The information sources and date range searched are described.
[Yes]
P8
Reasoning: The full search strategy is not presented for any of the databases searched.
[No]
P9
Quote: "The studies fitting the inclusion criteria were analysed for the following: journal of publication; period of review; type of study; country of origin; population demographics (age and gender); pre-operative imaging modalities used; stone size; total stone burden and location; type of anaesthesia utilised for procedure; and type of pre- and post-operative stent use."
Reasoning: The process for selecting studies based on the inclusion criteria is described.
[Yes]
P10
Quote: "The studies fitting the inclusion criteria were analysed for the following: journal of publication; period of review; type of study; country of origin; population demographics (age and gender); pre-operative imaging modalities used; stone size; total stone burden and location; type of anaesthesia utilised for procedure; and type of pre- and post-operative stent use."
Reasoning: The method of data extraction is described, but no mention of obtaining data in duplicate or from study investigators.
[No]
P11
Quote: "The studies fitting the inclusion criteria were analysed for the following: journal of publication; period of review; type of study; country of origin; population demographics (age and gender); pre-operative imaging modalities used; stone size; total stone burden and location; type of anaesthesia utilised for procedure; and type of pre- and post-operative stent use."
Reasoning: The data items collected are listed.
[Yes]
P12
Reasoning: No methods for assessing risk of bias in individual studies are described.
[No]
P13
Reasoning: The principal summary measures (stone-free rate and complication rate) are stated in the Methods and reported in the Results.
[Yes]
P14
Reasoning: Not applicable as no meta-analysis was performed.
[NA]
P15
Reasoning: No methods for assessing risk of bias across studies are described.
[No]
P16
Reasoning: No additional analyses were mentioned.
[No]
P17
Quote: See Figure 1 flow diagram.
Reasoning: A flow diagram is provided showing the number of studies screened, assessed for eligibility, included and excluded with reasons.
[Yes]
P18
Quote: "A total of six studies were found to fit the inclusion criteria from the literature search. These studies were published between 2008 and 2014 (Fig. 1). Three studies were published from Turkey, two were from USA and the final one was from Australia. All six studies were retrospective studies."
Reasoning: Some study characteristics are provided for each included study, but details are lacking. Citations are not provided.
[No]
P19
Reasoning: Risk of bias assessments for individual studies are not reported.
[No]
P20
Reasoning: Simple summary data for each study are not provided. Effect estimates and confidence intervals are not reported.
[No]
P21
Reasoning: Not applicable as no meta-analysis was performed.
[NA]
P22
Reasoning: Not applicable as risk of bias across studies was not assessed.
[NA]
P23
Reasoning: No additional analyses were reported.
[No]
P24
Quote: "The present review shows that, despite the small numbers studied, FURSL in the management of renal calculi in the paediatric population is an effective and safe procedure in high-volume centres. To keep improving outcomes, these procedures should be undertaken by experienced surgeons who are familiar with the difficulties encountered in the paediatric population."
Reasoning: The main findings are summarized, but the strength of evidence for each outcome is not provided.
[No]
P25
Quote: "The present systematic review highlights that FURSL can be used even for stones in lower pole locations, for stones up to 30 mm, and in children from the age of three months. The present review demonstrates an SFR of 85.5% (range 58.0-93.0%) and an overall complication rate of 12.4%. This is comparable with a recent study by Badawy et al. [15], which looked at SWL in urinary tract calculi in the paediatric population. They showed that the overall success rate was 83.4% for renal calculi and their complication rate was slightly higher at 15.0%, where no major complications were recorded."
Reasoning: Limitations at the review level are discussed, including the small number of studies and patients. Limitations at the study and outcome level are not addressed.
[No]
P26
Quote: "To compare the effectiveness and safety of FURSL in the paediatric population with the more conventional methods of SWL and PCNL, large, multicentre trials would be required. To facilitate the analysis of data, the outcomes measured should be reported in a uniform manner."
Reasoning: A general interpretation is provided in the context of comparing FURSL to other methods, with implications for future research suggested.
[Yes]
P27
Reasoning: Sources of funding and support for the systematic review are not reported.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
0
|
NA
|
NA
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
0
|
0
|
1
|
0
|
1
|
1
|
1
|
1
|
0
|
0
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
1
|
1
|
0
|
NA
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
NA
|
NA
|
0
|
1
|
0
|
0
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
0
|
0
|
0
|
1
|
0
|
0
|
NA
|
NA
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
0
|
0
|
0
|
1
|
1
|
NA
|
0
|
0
|
LLM response
21 quote(s) from
publication full text (mean similarity 98.2%)
A1
"The aim of the present review was to look at the role of ureteroscopy (URS) for treatment of paediatric stone disease. We conducted a systematic review using studies identified by a literature search between January 1990 and May 2013."
The review aim and inclusion criteria were established a priori.
[Yes]
A2
"Two reviewers independently extracted the data from each study."
At least two independent data extractors were involved.
[Yes]
A3
"The terms used in the search included the following: 'ureteroscopy', 'paediatric', 'pediatric', 'paediatrics', 'pediatrics', 'children', 'calculi', 'stones', 'laser', 'laser therapy' and 'urolithiasis'. Mesh phrases included the following: ('Ureteroscopy' [Mesh]) AND 'Paediatric' [Mesh], ('Calculi' [Mesh]) AND 'Ureteroscopy' [Mesh], ('Paediatric' [Mesh]) AND 'Stones' [Mesh], ('Paediatric' [Mesh]) AND ('Lasers' [Mesh] OR 'Laser Therapy' [Mesh]), ('Lasers' [Mesh]) AND 'Calculi' [Mesh]) AND (('Paediatric' [Mesh]), and ('Ureteroscopy' [Mesh]) AND ('Calculi' [Mesh]))."
A comprehensive search strategy using multiple databases and key terms was provided.
[Yes]
A4
"Only papers written in the English language were considered for inclusion. References of the searched studies were also evaluated for potential inclusion."
Only English language articles were included, no mention of including grey literature.
[No]
A5
No list of included and excluded studies was provided.
[No]
A6
"A total of 14 studies (Fig. 1), published during the period of January 1990 to May 2013, were found to fit the inclusion criteria. In total, 1718 procedures were carried out, with a range of 50–660 procedures per study (Tables 1,2 [2,6,11,16–26])."
The number of included studies and a range of their sample sizes were provided.
[No]
A7
"The quality of the included studies was assessed according to the Cochrane Collaboration and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist."
The scientific quality of included studies was assessed using the PRISMA checklist.
[Yes]
A8
"This review found there was a SFR of 86.3%, which compares well with the SFRs reported in studies of SWL in the treatment of paediatric stone disease."
The results of the quality assessment were considered in the review's conclusions.
[Yes]
A9
This systematic review did not perform a meta-analysis.
[NA]
A10
No assessment of publication bias was reported.
[No]
A11
No disclosure of conflicts of interest for the included studies.
[No]
P1
"Ureteroscopy for stone disease in the paediatric population: a systematic review"
The title identifies the article as a systematic review.
[Yes]
P2
The abstract is structured with labeled sections for background, objectives, data sources, study eligibility criteria, study appraisal and synthesis methods, results, limitations, and conclusions.
[Yes]
P3
"Paediatric stone disease has been on the rise in recent years [1,2]. The reason for this rise is multifactorial. Developmental abnormalities of the genitourinary system are known to contribute to stone formation. These abnormalities promote stasis of urine as well as recurrent UTIs and increase the potential for crystallization to occur."
The rationale for the review is described in the context of the increasing incidence of pediatric stone disease and contributing factors.
[Yes]
P4
"The aim of the present review was to look at the role of ureteroscopy (URS) for treatment of paediatric stone disease."
An explicit statement of the review question is provided, but without full PICOS elements.
[No]
P5
No mention of a review protocol or registration number.
[No]
P6
"To be included in this systematic review studies were required to have reported on at least 50 cases of paediatric patients (aged ≤18 years) who underwent URS for stone disease, and their outcomes. The variables that were of interest were the efficacy and safety of the procedures and any complications associated with them; these were graded according to the Clavien–Dindo criteria. The efficacy of the procedure was defined as the SFR and the need for any further procedures."
Study eligibility criteria related to patient age, sample size, and outcomes of interest were specified.
[Yes]
P7
"The terms used in the search included the following: 'ureteroscopy', 'paediatric', 'pediatric', 'paediatrics', 'pediatrics', 'children', 'calculi', 'stones', 'laser', 'laser therapy' and 'urolithiasis'. Mesh phrases included the following: ('Ureteroscopy' [Mesh]) AND 'Paediatric' [Mesh], ('Calculi' [Mesh]) AND 'Ureteroscopy' [Mesh], ('Paediatric' [Mesh]) AND 'Stones' [Mesh], ('Paediatric' [Mesh]) AND ('Lasers' [Mesh] OR 'Laser Therapy' [Mesh]), ('Lasers' [Mesh]) AND 'Calculi' [Mesh]) AND (('Paediatric' [Mesh]), and ('Ureteroscopy' [Mesh]) AND ('Calculi' [Mesh]))."
The databases and search terms used were described, but the dates of coverage and last search date were not reported.
[No]
P8
"The terms used in the search included the following: 'ureteroscopy', 'paediatric', 'pediatric', 'paediatrics', 'pediatrics', 'children', 'calculi', 'stones', 'laser', 'laser therapy' and 'urolithiasis'. Mesh phrases included the following: ('Ureteroscopy' [Mesh]) AND 'Paediatric' [Mesh], ('Calculi' [Mesh]) AND 'Ureteroscopy' [Mesh], ('Paediatric' [Mesh]) AND 'Stones' [Mesh], ('Paediatric' [Mesh]) AND ('Lasers' [Mesh] OR 'Laser Therapy' [Mesh]), ('Lasers' [Mesh]) AND 'Calculi' [Mesh]) AND (('Paediatric' [Mesh]), and ('Ureteroscopy' [Mesh]) AND ('Calculi' [Mesh]))."
The full search strategy was provided for at least one database (PubMed/MEDLINE).
[Yes]
P9
"Only papers written in the English language were considered for inclusion. References of the searched studies were also evaluated for potential inclusion. Authors of the relevant studies were contacted to verify data if unclear or unavailable."
The study selection process was described, including language restrictions and checking reference lists.
[Yes]
P10
"Two reviewers independently extracted the data which was then put into an Excel spread sheet. Studies meeting the inclusion criteria were analysed for the following variables: period of study, country of origin, stone size and location, population demographics (age and sex), type of anaesthetic used, number and type of procedure performed, method of stone extraction, use of stents (pre- and postoperatively), SFRs, procedure failures, procedure-related complications and hospital length of stay."
The data extraction process was described, involving two independent reviewers.
[Yes]
P11
"Studies meeting the inclusion criteria were analysed for the following variables: period of study, country of origin, stone size and location, population demographics (age and sex), type of anaesthetic used, number and type of procedure performed, method of stone extraction, use of stents (pre- and postoperatively), SFRs, procedure failures, procedure-related complications and hospital length of stay."
The data items collected were defined.
[Yes]
P12
"The quality of the included studies was assessed according to the Cochrane Collaboration and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist."
The PRISMA checklist was used to assess study quality, but the specific methods for incorporating this into data synthesis were not described.
[No]
P13
No summary measures were specified.
[No]
P14
This systematic review did not include a meta-analysis.
[NA]
P15
This systematic review did not include a meta-analysis.
[NA]
P16
This systematic review did not include a meta-analysis.
[NA]
P17
"A total of 14 studies (Fig. 1), published during the period of January 1990 to May 2013, were found to fit the inclusion criteria. In total, 1718 procedures were carried out, with a range of 50–660 procedures per study (Tables 1,2 [2,6,11,16–26])."
The number of studies screened, assessed for eligibility, and included was reported, but no flow diagram was provided and reasons for exclusions at each stage were not given.
[No]
P18
The characteristics of each included study, including sample size, patient age, stone location, SFR, and complications were provided in Tables 1-4.
[Yes]
P19
The quality assessment of individual studies was not presented.
[No]
P20
Data for each study was provided in tables, but no effect estimates or confidence intervals were reported.
[No]
P21
This systematic review did not include a meta-analysis.
[NA]
P22
This systematic review did not include a meta-analysis.
[NA]
P23
This systematic review did not include a meta-analysis.
[NA]
P24
"This review found there was a SFR of 86.3%, which compares well with the SFRs reported in studies of SWL in the treatment of paediatric stone disease. A recent study by Badawy et al. [27] reported SFRs of 83.4 and 58.5% in renal and ureteric calculi, respectively, in >500 patients."
The main findings and strength of evidence were summarized.
[Yes]
P25
"The present review has two limitations. Firstly, the majority of the studies reviewed were retrospective; only three of the studies included were prospective studies [19,23,26], which are less likely to be subject to various confounding factors and bias. The other limitation is that of publication bias. Despite the reported rise in the incidence of paediatric stone disease, only a small proportion reported significant volume (≥50 cases)."
Limitations at the study and review level were discussed.
[Yes]
P26
"The evidence from the present review suggests that the use of URS in the paediatric population for stone disease as the first-line surgical management is a safe and highly effective procedure. This technique has been used in paediatric patients, with stones located throughout the urinary system, to good effect."
A general interpretation of the results and implications for clinical practice were provided.
[Yes]
P27
"None declared."
Sources of funding for the systematic review were not described.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
1
|
1
|
1
|
1
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
0
|
NA
|
1
|
1
|
0
|
1
|
1
|
0
|
NA
|
1
|
0
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
0
|
1
|
1
|
1
|
1
|
1
|
0
|
NA
|
1
|
1
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
0
|
0
|
0
|
1
|
1
|
1
|
1
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
0
|
1
|
0
|
0
|
1
|
1
|
1
|
1
|
0
|
0
|
LLM response
24 quote(s) from
publication full text (mean similarity 95.5%)
1
quote(s) from the LLM prompt briefing (mean similarity 100%) -
were instructions quoted (ok) or examples (unwanted beahviour)?
A1
"The aim of this systematic review was to critically examine the existing literature regarding the effectiveness of tongue-tie division in infants with ankyloglossia, using the new grades of recommendations, assessment, development, and evaluation (GRADE) rating system."
The research question and inclusion criteria were established a priori.
[Yes]
A2
No relevant quotes found.
No mention of duplicate study selection and data extraction.
[No]
A3
"An electronic literature search was systematically performed using databases including PubMed (January1966–April 2013), Japana Centra Revuo Medicina (Igaku Chuo Zasshi), 1983–April 2013), CINAHL, and Cochrane Library using the key words "ankyloglossia," "tongue-tie," "frenotomy," and/or "breast-feeding" in English and Japanese."
A comprehensive literature search was performed using multiple databases and key words.
[Yes]
A4
"The literature selection criteria included RCT and observational studies (cohort studies, case–control studies, and case series) that matched the aforementioned patient selection criteria. Case reports, case series with <10 subjects, opinion articles without patient data, literature reviews, Q&As, and letters to the editor were excluded. Guidelines, guidance, and position statements of medical associations focused on the effects of frenotomy in infants with breast-feeding difficulties were included as references for the review."
The inclusion criteria did not restrict based on publication status.
[No]
A5
"A total of 505 titles and abstracts were retrieved with the initial search terms of ankyloglossia or tongue-tie. Via the secondary search, relevant full-texts were obtained for 114 articles, using the search with terms of "frenotomy," "frenuloplasty," or "breast-feeding." According to the exclusion criteria, case reports with <10 subjects, expert opinions, reviews, Q&As, and letters to the editor were eliminated."
A list of excluded studies was provided, but not a list of included studies.
[No]
A6
"For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations."
The characteristics of included studies were provided in an evidence table.
[Yes]
A7
"The literature was divided into two groups: RCT (high-quality group) and observational studies (low-quality group). In regard to the most important outcomes (sucking/latch and nipple pain), meta-analysis of observational studies, continued a small number of RCT and meta-analysis of observational studies, were rated either A (strong evidence) or B (moderate evidence); the other four important outcomes were rated C (weak evidence) because they were purely observational studies, contained a small number of subjects, and/or lacked controls."
The scientific quality of included studies was assessed and documented using the GRADE system.
[Yes]
A8
"Evidence levels of the most important outcomes (sucking/latch and nipple pain), presented by RCT and meta-analysis of observational studies, were rated either A (strong evidence) or B (moderate evidence); the other four important outcomes were rated C (weak evidence) because they were purely observational studies, contained a small number of subjects, and/or lacked controls."
The scientific quality was used appropriately in formulating conclusions, with strong/moderate evidence for key outcomes and weak evidence for others.
[Yes]
A9
"Meta-analysis was carried out using Review Manager (RevMan ver. 5.2) of the Cochrane Collaboration.11 Effect size was measured using risk ratio in dichotomous data and mean difference in continuous data with 95% confidence intervals (95%CI)."
Appropriate methods were used to combine the findings of studies in meta-analysis.
[Yes]
A10
No relevant quotes found.
Publication bias was not assessed.
[No]
A11
No relevant quotes found.
Conflicts of interest were not reported for the systematic review or included studies.
[No]
P1
"Does frenotomy improve breast-feeding difficulties in infants with ankyloglossia?"
The report is identified as a systematic review in the title.
[Yes]
P2
The abstract provides a structured summary including background, objective, data sources, study eligibility criteria, participants and interventions, appraisal and synthesis methods, results, limitations, and conclusions.
[Yes]
P3
"Ankyloglossia or tongue-tie is a congenital oral condition characterized by an abnormally short lingual frenulum, which restricts tongue movement. The length of attachment to the tongue and thickness of the frenulum vary widely in degree. It is often classified into mild "partial ankyloglossia", which is common, and severe as well as rare "complete ankyloglossia", where the tongue is fused to the floor of the mouth."
The introduction describes the rationale for the review in the context of what is already known about ankyloglossia.
[Yes]
P4
"The aim of this systematic review was to critically examine the existing literature regarding the effectiveness of tongue-tie division in infants with ankyloglossia, using the new grades of recommendations, assessment, development, and evaluation (GRADE) rating system. A clinical question was structured according to patient, intervention, comparison, and outcome, as follows: in infants with poor breast-feeding and ankyloglossia (patient), does frenotomy (intervention), compared to lactation support alone (comparison), improve feeding (outcome)?"
The introduction provides an explicit statement of the review question with reference to PICO.
[Yes]
P5
No relevant quotes found.
No mention of a review protocol or registration.
[No]
P6
"Literature that focused on neonates and infants <6 months of age who had breast-feeding problems and ankyloglossia was selected for analysis. Patients who suffered from other oral anomalies and disturbances of the central nervous system were excluded from the review."
Study characteristics and report characteristics used as eligibility criteria are specified.
[Yes]
P7
"An electronic literature search was systematically performed using databases including PubMed (January1966–April 2013), Japana Centra Revuo Medicina (Igaku Chuo Zasshi), 1983–April 2013), CINAHL, and Cochrane Library using the key words "ankyloglossia," "tongue-tie," "frenotomy," and/or "breast-feeding" in English and Japanese. The search was limited to articles written in English and Japanese."
All information sources searched and the date range are described.
[Yes]
P8
No relevant quotes found.
The full electronic search strategy is not presented.
[No]
P9
"A total of 505 titles and abstracts were retrieved with the initial search terms of ankyloglossia or tongue-tie. Via the secondary search, relevant full-texts were obtained for 114 articles, using the search with terms of "frenotomy," "frenuloplasty," or "breast-feeding." According to the exclusion criteria, case reports with <10 subjects, expert opinions, reviews, Q&As, and letters to the editor were eliminated. After adding four articles by hand-searching, four RCT, 12 observational studies,12–23 National Institute for Health and Care Excellence (NICE) guidance,24 a guideline by the Academy of Breast feeding Medicine (ABM),25 and a position statement of the Canadian Paediatric Society26 met the criteria for the review (Fig. 1)."
The process for selecting studies is stated.
[Yes]
P10
No relevant quotes found.
The method of data extraction is not described.
[No]
P11
"The primary outcome measures regarding breast-feeding problems associated with ankyloglossia and their relative importance are listed in Table 1. Sucking/latch and nipple pain were rated as the most important outcomes, because these two outcomes were considered to be the main reasons for abandoning breast-feeding. Milk supply/milk production, continuation of breast-feeding, weight gain, adverse events, and dyad distress were rated as relatively less important outcomes."
The outcomes for which data were sought are defined.
[Yes]
P12
"The literature was divided into two groups: RCT (high-quality group) and observational studies (low-quality group). In regard to the most important outcomes (sucking/latch and nipple pain), meta-analysis of observational studies, continued a small number of RCT and meta-analysis of observational studies, were rated either A (strong evidence) or B (moderate evidence); the other four important outcomes were rated C (weak evidence) because they were purely observational studies, contained a small number of subjects, and/or lacked controls."
The methods used for assessing risk of bias of individual studies are described.
[Yes]
P13
"Meta-analysis was carried out using Review Manager (RevMan ver. 5.2) of the Cochrane Collaboration.11 Effect size was measured using risk ratio in dichotomous data and mean difference in continuous data with 95% confidence intervals (95%CI)."
The principal summary measures are stated (risk ratio and mean difference).
[Yes]
P14
"Meta-analysis was carried out using Review Manager (RevMan ver. 5.2) of the Cochrane Collaboration.11 Effect size was measured using risk ratio in dichotomous data and mean difference in continuous data with 95% confidence intervals (95%CI)."
The methods of handling data and combining results are described.
[Yes]
P15
No relevant quotes found.
No methods for assessing risk of bias across studies are specified.
[No]
P16
No relevant quotes found.
No methods of additional analyses are described.
[No]
P17
"A total of 505 titles and abstracts were retrieved with the initial search terms of ankyloglossia or tongue-tie. Via the secondary search, relevant full-texts were obtained for 114 articles, using the search with terms of "frenotomy," "frenuloplasty," or "breast-feeding." According to the exclusion criteria, case reports with <10 subjects, expert opinions, reviews, Q&As, and letters to the editor were eliminated. After adding four articles by hand-searching, four RCT, 12 observational studies,12–23 National Institute for Health and Care Excellence (NICE) guidance,24 a guideline by the Academy of Breast feeding Medicine (ABM),25 and a position statement of the Canadian Paediatric Society26 met the criteria for the review (Fig. 1)."
A flow diagram is provided with the numbers of studies screened, assessed for eligibility, included and excluded with reasons.
[Yes]
P18
The characteristics of each included study are presented in an evidence table with citations.
[Yes]
P19
"The literature was divided into two groups: RCT (high-quality group) and observational studies (low-quality group). In regard to the most important outcomes (sucking/latch and nipple pain), meta-analysis of observational studies, continued a small number of RCT and meta-analysis of observational studies, were rated either A (strong evidence) or B (moderate evidence); the other four important outcomes were rated C (weak evidence) because they were purely observational studies, contained a small number of subjects, and/or lacked controls."
Data on the risk of bias of each study are presented.
[Yes]
P20
Results for individual studies are presented in the meta-analysis forest plots, including summary data for each group and effect estimates with confidence intervals.
[Yes]
P21
Meta-analysis results are presented with forest plots showing effect estimates and confidence intervals.
[Yes]
P22
No relevant quotes found.
No results of assessment of risk of bias across studies are presented.
[No]
P23
No relevant quotes found.
No additional analyses were conducted.
[NA]
P24
"The results of this systematic review are summarized in the evidence profile (Table 6). The results of outcomes consistently showed the effectiveness of frenotomy for breast-feeding difficulties in infants with ankyloglossia. No major complications from frenotomy, most likely because it was performed by well-trained health-care professionals."
The main findings are summarized including the strength of evidence for each main outcome.
[Yes]
P25
"The quality of the literature was rated in regard to the two most important outcomes (sucking/latch and nipple pain) and five relatively less important outcomes (milk supply/milk production, continuation of breast-feeding, weight gain, adverse events, and dyad distress) according to the GRADE system.
Sucking or latch was difficult to assess independently from other outcomes because maternal subjective outcome measures included nipple pain, feeding time, infant satisfaction, and maternal distress. The objective assessment of the LATCH score also includes nipple pain as an assessment item."
Limitations at the study and outcome level are discussed.
[Yes]
P26
"A systematic review based on the GRADE system was conducted to examine the clinical question, does frenotomy improve breast-feeding difficulties in infants with ankyloglossia. In accordance with the current criteria, four RCT and 12 observational studies were included in this review. The evidence levels of the two most important outcomes (sucking/latch and nipple pain) were rated either A (strong evidence) or B (moderate evidence); the other four less important outcomes were rated C (weak evidence), and every outcome consistently showed the effectiveness of frenotomy for breast-feeding difficulties. No serious adverse events were reported."
A general interpretation of the results is provided in the context of other evidence, with implications for practice.
[Yes]
P27
No relevant quotes found.
Sources of funding for the systematic review are not described.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
0
|
0
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
1
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
0
|
NA
|
1
|
1
|
1
|
1
|
1
|
0
|
NA
|
1
|
1
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
0
|
1
|
1
|
1
|
1
|
1
|
0
|
0
|
1
|
1
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
0
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
1
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
LLM response
25 quote(s) from
publication full text (mean similarity 98.1%)
A1 - Was an 'a priori' design provided?
Quote: "The aim of the study was to compare the outcome after laparoscopic pyloromyotomy (LP) with those of open pyloromyotomy (OP) for infantile pyloric stenosis."
Reasoning: The aim of the study was stated, but no mention of a protocol, ethics approval, or pre-determined objectives.
[No]
A2 - Was there duplicate study selection and data extraction?
Quote: "Data were extracted by 2 independent investigators, and discrepancies were discussed to reach consensus."
Reasoning: Two independent investigators performed data extraction and resolved discrepancies by consensus.
[Yes]
A3 - Was a comprehensive literature search performed?
Quotes: "An electronic literature search of all articles from inception to February 2009 was conducted using Medline, the Cochrane Library, ISI, EMBASE, and the Chinese Biomedical Literature Database, using the following text and keywords in combination both as MeSH terms and text words: "pyloric stenosis", "pyloromyotomy", "pyloromyotomies" and "pyloromyotomy" in combination with "laparoscop*". The China Journal Fulltext Database (from 1994 to February 2009), Chinese biological medicine disc (from 1978 to February 2009), Chinese Scientific Journals Fulltext Database (from 1989 to February 2009) and Wanfang Database (from 1997 to February 2009) were also searched using the above terms."
Reasoning: At least 2 electronic databases were searched, key terms were provided, and additional sources like Chinese databases were searched.
[Yes]
A4 - Was the status of publication (i.e. grey literature) used as an inclusion criterion?
Quotes: "Further searches were done by manually reviewing abstract booklets, conference proceedings and review articles. Investigators were contacted for additional data if included outcomes were not published."
Reasoning: Conference proceedings and abstract booklets were searched, and investigators were contacted for unpublished data.
[Yes]
A5 - Was a list of studies (included and excluded) provided?
Quote: "The literature searches yielded 461 potentially relevant articles. After a review of the titles, abstracts and removal of duplicates, 17 articles were selected for further evaluation. When inclusion criteria were applied, 3 randomized controlled trials with 492 infants were finally eligible for this study (Fig. 1)."
Reasoning: A flow diagram of study selection was provided, but no list of excluded studies.
[No]
A6 - Were the characteristics of the included studies provided?
Quote: "Baseline characteristics of included trials are summarized in Table 1. The 3 studies spanned the period 1999-2007 and 2 large studies [10,13] even overlapped by 33 months, which means these 2 were carried out during the same 33 months of their respective duration."
Reasoning: Key characteristics of the included studies like time period and overlap were provided in aggregate form.
[Yes]
A7 - Was the scientific quality of the included studies assessed and documented?
Quote: "Using the quality assessment instrument of the Cochrane Handbook version 5.0.1 [11], we assigned 'Yes' for low risk of bias, 'No' for high risk of bias, or 'Unclear' for uncertain risk of bias. All studies described an adequate random sequence generation, allocation concealment and blinding. After retrieving included articles, no incomplete outcome data and selective outcome reporting were found (Table 2)."
Reasoning: The Cochrane risk of bias tool was used to assess study quality, and the results for each study were reported.
[Yes]
A8 - Was the scientific quality of the included studies used appropriately in formulating conclusions?
Reasoning: The authors did not appear to consider study quality when formulating the conclusions of the review.
[No]
A9 - Were the methods used to combine the findings of studies appropriate?
Quote: "Statistical analysis was performed using RevMan 5.0.8. The results are expressed as SMD for continuous variables and OR for dichotomous outcomes; 95% confidence intervals (CIs) are also reported."
Reasoning: Appropriate statistical methods were used to combine the study findings in a meta-analysis.
[Yes]
A10 - Was the likelihood of publication bias assessed?
Reasoning: The review did not mention assessing publication bias.
[No]
A11 - Was the conflict of interest included?
Reasoning: The review did not report sources of support or conflicts of interest for the systematic review itself or the included studies.
[No]
P1 - Title
Quote: "Open versus Laparoscopic Pyloromyotomy for Pyloric Stenosis: A Meta-analysis of Randomized Controlled Trials"
Reasoning: The title identifies the article as a meta-analysis of randomized controlled trials.
[Yes]
P2 - Abstract / Structured summary
Quote: The abstract contains labeled sections for Objective, Methods, Results, and Conclusions.
Reasoning: The abstract is structured with distinct sections covering the main PRISMA elements.
[Yes]
P3 - Introduction / Rationale
Quote: "Ramstedt pyloromyotomy is easily performed and associated with minimal complications [5]. But in the 1990s, with the advance of minimally invasive surgery in infants, laparoscopic approaches have become progressively more popular and have replaced the open approach in many institutions [6,7]."
Reasoning: The rationale for the review is provided in the context of the increasing use of laparoscopic vs open pyloromyotomy.
[Yes]
P4 - Introduction / Objectives
Quote: "The aim of the study was to compare the outcome after laparoscopic pyloromyotomy (LP) with those of open pyloromyotomy (OP) for infantile pyloric stenosis."
Reasoning: An explicit objective statement is provided referencing the participants, interventions and outcomes of interest.
[Yes]
P5 - Methods / Protocol and registration
Reasoning: No mention of a review protocol or registration number.
[No]
P6 - Methods / Eligibility criteria
Quote: "Eligible studies were those that compared LP with OP for the treatment of infants with IHPS, and only randomized controlled trials was reviewed. The included studies had to report at least one of the following outcomes: complications during and following pyloromyotomy, the secondary endpoints included time to goal feeds, length of stay after surgery and operative time."
Reasoning: The eligibility criteria for study characteristics (RCTs of LP vs OP for IHPS) and report characteristics (complication and secondary outcome data) are specified.
[Yes]
P7 - Methods / Information sources
Quote: "An electronic literature search of all articles from inception to February 2009 was conducted using Medline, the Cochrane Library, ISI, EMBASE, and the Chinese Biomedical Literature Database, using the following text and keywords in combination both as MeSH terms and text words: "pyloric stenosis", "pyloromyotomy", "pyloromyotomies" and "pyloromyotomy" in combination with "laparoscop*". The China Journal Fulltext Database (from 1994 to February 2009), Chinese biological medicine disc (from 1978 to February 2009), Chinese Scientific Journals Fulltext Database (from 1989 to February 2009) and Wanfang Database (from 1997 to February 2009) were also searched using the above terms."
Reasoning: The electronic databases searched are described along with the date range of the search.
[Yes]
P8 - Methods / Search
Quote: The full search strategies are not provided.
Reasoning: The keywords are listed but the full reproducible search strategy is not reported for any database.
[No]
P9 - Methods / Study selection
Quote: "The literature searches yielded 461 potentially relevant articles. After a review of the titles, abstracts and removal of duplicates, 17 articles were selected for further evaluation. When inclusion criteria were applied, 3 randomized controlled trials with 492 infants were finally eligible for this study (Fig. 1)."
Reasoning: The process of screening, eligibility assessment, and inclusion is described.
[Yes]
P10 - Methods / Data collection process
Quote: "Data were extracted by 2 independent investigators, and discrepancies were discussed to reach consensus."
Reasoning: The data extraction process is described, involving two independent investigators and consensus resolution.
[Yes]
P11 - Methods / Data items
Reasoning: The review does not explicitly state all the variables for which data were sought.
[No]
P12 - Methods / Risk of bias in individual studies
Quote: "Using the quality assessment instrument of the Cochrane Handbook version 5.0.1 [11], we assigned 'Yes' for low risk of bias, 'No' for high risk of bias, or 'Unclear' for uncertain risk of bias."
Reasoning: The Cochrane risk of bias tool was used to assess risk of bias in the included studies.
[Yes]
P13 - Methods / Summary measures
Quote: "The primary endpoints in this review were complications during and following pyloromyotomy, the secondary endpoints included time to goal feeds, length of stay after surgery and operative time."
Reasoning: The primary and secondary outcome measures are stated.
[Yes]
P14 - Methods / Synthesis of results
Quote: "Statistical analysis was performed using RevMan 5.0.8. The results are expressed as SMD for continuous variables and OR for dichotomous outcomes; 95% confidence intervals (CIs) are also reported."
Reasoning: The meta-analysis methods, effect measures, and assessment of consistency are described.
[Yes]
P15 - Methods / Risk of bias across studies
Reasoning: Methods for assessing risk of bias across studies, such as publication bias, are not mentioned.
[No]
P16 - Methods / Additional analyses
Reasoning: No additional analyses such as subgroup analyses or meta-regression are mentioned.
[No]
P17 - Results / Study selection
Quote: See Figure 1 flow diagram.
Reasoning: The flow diagram provides the numbers of studies screened, assessed for eligibility, included, and excluded with reasons.
[Yes]
P18 - Results / Study characteristics
Quote: See Table 1 for study characteristics.
Reasoning: Table 1 presents key characteristics of the included studies like sample size, interventions, and outcomes.
[Yes]
P19 - Results / Risk of bias within studies
Quote: See Table 2 for quality assessment of included studies.
Reasoning: Table 2 presents the Cochrane risk of bias assessments for each included study.
[Yes]
P20 - Results / Results of individual studies
Quote: See Table 3 and Table 4 for results of individual studies.
Reasoning: Tables 3 and 4 present the effect estimates and confidence intervals for each outcome from the individual studies.
[Yes]
P21 - Results / Synthesis of results
Quote: See Table 3 for meta-analysis results.
Reasoning: Table 3 presents the pooled effect estimates, confidence intervals, and heterogeneity measures for each outcome.
[Yes]
P22 - Results / Risk of bias across studies
Reasoning: The results do not include an assessment of risk of bias across studies, such as a funnel plot for publication bias.
[No]
P23 - Results / Additional analysis
Reasoning: No additional analyses such as subgroup analyses or meta-regression were reported.
[No]
P24 - Discussion / Summary of evidence
Quote: "The analyzed data confirmed that LP has a similar rate of complications, both perioperatively and postoperatively. However, the LP group seemed to have a slightly higher rate of incomplete pyloromyotomies requiring a repeat procedure, with 6 cases occurring out of a total of 137 infants (4.38%) compared to none in the OP group (9,10). This is in line with other published series which reported an incidence of incomplete pyloromyotomies of between 2% and 8% [14-16], whereas this complication is extremely uncommon with OP procedures [17]."
Reasoning: The main findings are summarized, including the similar complication rates between LP and OP but slightly higher incomplete pyloromyotomy rate with LP.
[Yes]
P25 - Discussion / Limitations
Quote: "As with any systematic review, the limitations of this study reflect those of the individual studies. Most relied on information from databases. In this review, all trials included were obtained from online databases and no other articles were reviewed. Thus, a publication bias probably existed, although we did not assess this in detail because of the small numbers of trials that could be pooled. The heterogeneity of some variables in this study is also worthy of comment. 3 variables (full time to feed, length of stay after surgery, operating time) exhibited significant heterogeneity, as indicated by the I2 values which were all above 50%. Possible explanations include the following factors: First, the studies were all from different centers. Second, the procedures were performed by a number of different surgeons with different levels of skill and proficiency. Third, different centers may be at different points on the learning curve for LP."
Reasoning: Several limitations of the review are discussed, including publication bias, heterogeneity among the included studies, and differences between centers and surgeons.
[Yes]
P26 - Discussion / Conclusions
Quote: "Overall, this systematic review has shown a similar frequency of complications for LP and OP procedures. Furthermore, it also showed a trend toward shorter times for LP. Nevertheless, the conclusions from this study remain somewhat limited due to the small sample size."
Reasoning: The conclusions provide a general interpretation of the results in the context of the limitations of the small sample size.
[Yes]
P27 - Funding
Reasoning: The review does not report sources of funding or other support.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
1
|
1
|
1
|
0
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
0
|
0
|
1
|
0
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
0
|
1
|
0
|
0
|
0
|
0
|
0
|
NA
|
1
|
1
|
1
|
1
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
1
|
0
|
0
|
0
|
1
|
1
|
0
|
1
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
0
|
0
|
0
|
0
|
0
|
1
|
0
|
0
|
LLM response
29 quote(s) from
publication full text (mean similarity 99.2%)
Here is the assessment of the systematic review using AMSTAR and PRISMA:
A1. Was an 'a priori' design provided?
Quote: "The review was performed according to the PRISMA guidelines (Appendix 1)."
Reasoning: The authors state the review was conducted according to PRISMA guidelines, implying an a priori design.
[Yes]
A2. Was there duplicate study selection and data extraction?
Quotes: "Abstracts for all articles were independently subjected to preliminary review by two investigators (JA, SK) to determine whether inclusion criteria were satisfied. A third reviewer (JT) resolved disagreement between reviewers." and "A standard data collection form (Appendix 2) created by the authors (JA, JT, SK) was used to extract information about study quality, including overall and per-group sample sizes,"
Reasoning: Study selection and data extraction were done independently by multiple reviewers.
[Yes]
A3. Was a comprehensive literature search performed?
Quotes: "We reviewed Medline citations, as well as the Cochrane Database of Systematic Reviews, between January 1, 1996 and June 1, 2012." and "Articles were identified using the search term "gastroschisis" and [("treatment outcome" or "prognosis") or randomized controlled trials]."
Reasoning: At least 2 databases were searched using relevant search terms.
[Yes]
A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion?
Reasoning: No mention of including or excluding studies based on publication status or searching for grey literature.
[No]
A5. Was a list of studies (included and excluded) provided?
Reasoning: Figure 1 provides a flow diagram of included and excluded studies with reasons for exclusions, but does not provide a full list.
[No]
A6. Were the characteristics of the included studies provided?
Quotes: "Data for birth weight and gestational age by type of closure were provided for 16 studies, and neither birth weight nor gestational age was strongly associated with study effects (Table 3)." and "However, the following variables were moderately (0.3>r>0.7) associated: birth weight and gestational age with ventilator days and TTiF; gestational age with NEC and mortality; and birth weight with TFuF and PND."
Reasoning: Some aggregate characteristics of included studies were provided, but not in table format for each study.
[No]
A7. Was the scientific quality of the included studies assessed and documented?
Quote: "Heterogeneity was assessed by the I2 statistic, which is a measure of the proportion of variance across studies that can be attributed to heterogeneity rather than chance."
Reasoning: Heterogeneity, which reflects study quality, was assessed using I2 statistic. However, no other formal quality assessment was reported.
[No]
A8. Was the scientific quality of the included studies used appropriately in formulating conclusions?
Reasoning: The authors did not assess study quality, so it was not incorporated into the conclusions.
[No]
A9. Were the methods used to combine the findings of studies appropriate?
Quotes: "The data were analyzed using standard meta-analytic techniques (18). For each study, treatment effects were calculated using a fixed effect model to obtain weighted mean difference and 95% confidence interval for continuous outcomes, and odds ratio and 95% confidence interval for dichotomous outcomes." and "To assess potential bias associated with subjectivity in study design and the inherent clinical variability of gastroschisis present challenges in interpreting and comparing studies to determine the best method to close a gastroschisis defect."
Reasoning: Appropriate meta-analytic methods were used to combine study findings. The authors also acknowledged challenges in comparing studies.
[Yes]
A10. Was the likelihood of publication bias assessed?
Reasoning: No assessment of publication bias was reported.
[No]
A11. Was the conflict of interest included?
Quote: "All authors have made substantive intellectual contributions to this study and have met the following criteria:"
Reasoning: The authors disclose their contributions but not explicit conflicts of interest or funding sources. The included studies were not assessed for conflicts of interest.
[No]
P1. Title
Quote: "Primary Fascial Closure versus Staged Closure with Silo in Patients with Gastroschisis: A Meta-Analysis"
Reasoning: The title identifies the report as a meta-analysis.
[Yes]
P2. Abstract / Structured summary
Reasoning: The abstract has distinct labeled sections covering background, methods, results and conclusions.
[Yes]
P3. Introduction / Rationale
Quote: "Gastroschisis is the most common congenital abdominal wall defect. Despite advances in the surgical closure of gastroschisis, consensus is lacking as to which method results in the best patient outcomes. The purpose of this meta-analysis was to compare short-term outcomes associated with primary fascial closure and staged repair with a silo in patients with gastroschisis."
Reasoning: The introduction describes the rationale for the review in the context of what is known.
[Yes]
P4. Introduction / Objectives
Quote: "The purpose of this meta-analysis was to compare short-term outcomes associated with primary fascial closure and staged repair with a silo in patients with gastroschisis."
Reasoning: The objective specifies the population, interventions and outcomes of interest.
[Yes]
P5. Methods / Protocol and registration
Reasoning: No mention of a pre-specified protocol or registration number.
[No]
P6. Methods / Eligibility criteria
Quote: "Case reports, reviews, letters, abstracts only, non-English abstracts, and studies that did not address at least one of the outcomes of interest were identified and excluded independently by two reviewers. Studies were also excluded from analysis when continuous outcomes were reported in a non-continuous manner or for which a minimum of number and SD or SE value were not provided."
Reasoning: Eligibility criteria for study characteristics and report characteristics are described.
[Yes]
P7. Methods / Information sources
Quote: "We reviewed Medline citations between January 1, 1996 and June 1, 2012 and the Cochrane Database of Systematic Reviews database through June 1, 2012. Citations from DynaMed and other reviews were included."
Reasoning: The databases searched and dates of coverage are provided.
[Yes]
P8. Methods / Search
Quote: "Articles were identified using the search term "gastroschisis" and [("treatment outcome" or "prognosis") or randomized controlled trials]."
Reasoning: The full search strategy is provided for one database.
[Yes]
P9. Methods / Study selection
Quote: "Abstracts for all articles were independently subjected to preliminary review by two investigators (JA, SK) to determine whether inclusion criteria were satisfied. A third reviewer (JT) resolved disagreement between reviewers."
Reasoning: The process for selecting studies is described.
[Yes]
P10. Methods / Data collection process
Quote: "A standard data collection form (Appendix 2) created by the authors (JA, JT, SK) was used to extract information about study quality, including overall and per-group sample sizes,"
Reasoning: A standard data collection form was used to extract data.
[Yes]
P11. Methods / Data items
Reasoning: The variables for which data were sought are not explicitly defined.
[No]
P12. Methods / Risk of bias in individual studies
Quote: "Heterogeneity was assessed by the I2 statistic, which is a measure of the proportion of variance across studies that can be attributed to heterogeneity rather than chance."
Reasoning: Heterogeneity was assessed using I2, but no other risk of bias assessment was described.
[No]
P13. Methods / Summary measures
Quote: "For each study, treatment effects were calculated using a fixed effect model to obtain weighted mean difference and 95% confidence interval for continuous outcomes, and odds ratio and 95% confidence interval for dichotomous outcomes."
Reasoning: The summary measures (weighted mean difference, odds ratio) are stated.
[Yes]
P14. Methods / Synthesis of results
Quote: "The data were analyzed using standard meta-analytic techniques (18)."
Reasoning: Standard meta-analytic techniques were used, but measures of consistency like I2 are not reported for each meta-analysis.
[No]
P15. Methods / Risk of bias across studies
Reasoning: No description of assessment of risk of bias across studies like publication bias or selective reporting.
[No]
P16. Methods / Additional analyses
Reasoning: No additional analyses like sensitivity analysis or meta-regression are mentioned.
[No]
P17. Results / Study selection
Quote: "After review of the remaining 108 abstracts and/or full text articles by two independent reviewers, studies that did not address gastroschisis repair methods and studies that did not address at least one of the outcomes of interest (n=88) were excluded. Twenty studies met inclusion criteria and were included in the meta-analysis: 1 randomized controlled trial, 3 prospective cohort studies, and 16 retrospective studies (Table 1)."
Reasoning: The number of studies screened, assessed for eligibility, included and excluded are provided with reasons in the text and Figure 1 flow diagram.
[Yes]
P18. Results / Study characteristics
Reasoning: Study characteristics like sample size, PICOS, and follow-up period are not presented for each included study.
[No]
P19. Results / Risk of bias within studies
Reasoning: No presentation of risk of bias assessment for each included study.
[No]
P20. Results / Results of individual studies
Reasoning: Simple summary data and effect estimates for each study are not provided for any outcomes. Forest plots are not included.
[No]
P21. Results / Synthesis of results
Reasoning: Meta-analysis was performed but the results are not presented with confidence intervals and measures of consistency.
[No]
P22. Results / Risk of bias across studies
Reasoning: No results of assessment of risk of bias across studies like publication bias.
[No]
P23. Results / Additional analysis
Reasoning: No additional analyses were reported.
[NA]
P24. Discussion / Summary of evidence
Quote: "Silo closure is associated with better clinical outcomes in the studies with the least selection bias. This is especially relevant to the group of patients for whom primary closure is not readily achievable but whose presentation is so complex as to immediately warrant delayed closure; for these patients, the evidence suggests that silo closure may be preferable."
Reasoning: The main findings are summarized with consideration of their relevance to key groups.
[Yes]
P25. Discussion / Limitations
Quote: "First, we identified the following three major variations in study design: 1) manner of selection of gastroschisis closure method, 2) inclusion of patients receiving surgically sutured silos in the silo group, and 3) inclusion of patients with complicated gastroschisis (including atresia, volvulus, and perforation). Such heterogeneity of study design and the inherent clinical variability of gastroschisis present challenges in interpreting and comparing studies to determine the best method to close a gastroschisis defect."
Reasoning: Limitations at the review level are discussed.
[Yes]
P26. Discussion / Conclusions
Quote: "This analysis highlights the heterogeneity of the available literature on closure methods for gastroschisis and the impact of study design on reported outcomes. Determining a superior method of closure would be a benefit to both the surgical and medical management of gastroschisis; this meta-analysis demonstrates that further well-designed studies are needed to gain an accurate picture of outcomes after different surgical interventions."
Reasoning: The conclusions provide a general interpretation in the context of other evidence and implications for future research.
[Yes]
P27. Funding
Quote: "The Seattle Children's Core for Biomedical Statistics is supported by the Center for Clinical and Translational Research at Seattle Children's Research Institute and grant UL1RR025014 from the NIH National Center for Research Resources."
Reasoning: Sources of funding for the systematic review are reported.
[Yes]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
1
|
0
|
NA
|
NA
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
0
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
NA
|
NA
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
1
|
1
|
0
|
NA
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
NA
|
NA
|
1
|
1
|
NA
|
NA
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
1
|
0
|
0
|
0
|
1
|
0
|
0
|
NA
|
NA
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
0
|
1
|
0
|
1
|
1
|
0
|
NA
|
NA
|
NA
|
0
|
LLM response
17 quote(s) from
publication full text (mean similarity 99.3%)
A1
Quote: "This study was performed according to guidelines from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) [6]. An online database search for all articles published between January 1993 and January 2014 on pediatric patients using the following keywords was performed: "heterotaxy", "rotation", "volvulus", "Ladd procedure", "Ivemark", "asplenia", and "polysplenia"."
Reasoning: The authors mention following PRISMA guidelines, which require an a priori design.
[Yes]
A2
No relevant quotes found.
Reasoning: The authors do not mention duplicate study selection and data extraction.
[No]
A3
Quote: "An online database search for all articles published between January 1993 and January 2014 on pediatric patients using the following keywords was performed: "heterotaxy", "rotation", "volvulus", "Ladd procedure", "Ivemark", "asplenia", and "polysplenia". Searches were repeated in PubMed, Medline, CINAHL, and Cochrane library."
Reasoning: At least two databases (PubMed, Medline, CINAHL, Cochrane) were searched with keywords provided.
[Yes]
A4
No relevant quotes found.
Reasoning: The authors do not mention searching for grey literature or unpublished studies.
[No]
A5
Quote: "Fig. 1 Flow diagram summary of literature vetting process."
Reasoning: A flow diagram is provided showing the number of studies included and excluded at each stage.
[Yes]
A6
Quote: "Table 1 Group characteristics of included studies."
Reasoning: A table of study characteristics is provided including time frame, number of patients, prophylactic Ladd's, and volvulus rates.
[Yes]
A7
Quote: "Because of the absence of randomized controlled trials and the heterogeneous nature of studies, a formal meta-analysis was not performed."
Reasoning: The authors mention the heterogeneous nature of studies precluded a formal meta-analysis, but do not describe assessing study quality.
[No]
A8
[NA] - No assessment of study quality was described.
A9
[NA] - No meta-analysis was performed.
A10
[NA] - No meta-analysis was performed.
A11
No relevant quotes found.
Reasoning: Sources of funding and conflicts of interest are not reported.
[No]
P1
Quote: "Observation versus prophylactic Ladd procedure for asymptomatic intestinal rotational abnormalities in heterotaxy syndrome: A systematic review"
Reasoning: The title identifies the article as a systematic review.
[Yes]
P2
Quote: "Background: The management of intestinal rotational abnormalities (IRA) in heterotaxy syndrome (HS) remains inconsistent. Because of the high incidence of malrotation in HS, screening of asymptomatic patients is standard of care in some institutions. The Ladd procedure is the treatment for malrotation, and has been reported to have high complication rates in HS patients.
Methods: We performed a systematic review of publications describing IRA in pediatric HS patients from January 1993 to present. The incidence of volvulus on surgical exploration was determined. Perioperative and long-term outcomes were analyzed to determine complication and mortality rates."
Reasoning: The abstract provides a structured summary with labeled sections for background, methods, and results.
[Yes]
P3
Quote: "Heterotaxy syndrome (HS), a consequence of aberrations in left-to-right positional signaling in early embryonic development, manifests as cardiac and visceral anatomic malpositioning. Forty percent to 90% of patients with HS also have intestinal rotational abnormalities (IRA) [1]."
Reasoning: The introduction describes the rationale for the review in the context of what is known about heterotaxy syndrome and intestinal rotational abnormalities.
[Yes]
P4
Quote: "To illustrate this, a study revealed a stable platform for infants with HS believe that all should be screened for IRA [3]."
Reasoning: The introduction alludes to the review question of screening vs not screening for IRA in HS patients, but does not provide an explicit PICOS statement.
[No]
P5
Quote: "This study was performed according to guidelines from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) [6]."
Reasoning: The methods mention following PRISMA guidelines, but do not provide a link to the protocol or registration number.
[No]
P6
Quote: "An online database search for all articles published between January 1993 and January 2014 on pediatric patients using the following keywords was performed: "heterotaxy", "rotation", "volvulus", "Ladd procedure", "Ivemark", "asplenia", and "polysplenia". Searches were repeated in PubMed, Medline, CINAHL, and Cochrane library."
Reasoning: The methods specify the databases, date range, keywords, and population (pediatric patients) used as eligibility criteria.
[Yes]
P7
Quote: "An online database search for all articles published between January 1993 and January 2014 on pediatric patients using the following keywords was performed: "heterotaxy", "rotation", "volvulus", "Ladd procedure", "Ivemark", "asplenia", and "polysplenia". Searches were repeated in PubMed, Medline, CINAHL, and Cochrane library."
Reasoning: The information sources (PubMed, Medline, CINAHL, Cochrane) and date range (1993-2014) are provided.
[Yes]
P8
No relevant quotes found.
Reasoning: The full search strategy is not presented for any of the databases.
[No]
P9
Quote: "Fig. 1 Flow diagram summary of literature vetting process."
Reasoning: A flow diagram is provided showing the process of screening, eligibility, and inclusion.
[Yes]
P10
No relevant quotes found.
Reasoning: The data extraction process is not described.
[No]
P11
No relevant quotes found.
Reasoning: The data items collected are not defined.
[No]
P12
[NA] - No assessment of risk of bias in individual studies was described.
P13
[NA] - No meta-analysis was performed.
P14
[NA] - No meta-analysis was performed.
P15
[NA] - No meta-analysis was performed.
P16
[NA] - No meta-analysis was performed.
P17
Quote: "Fig. 1 Flow diagram summary of literature vetting process."
Reasoning: A flow diagram is provided showing the number of studies screened, assessed for eligibility, included and excluded with reasons at each stage.
[Yes]
P18
Quote: "Table 1 Group characteristics of included studies."
Reasoning: A table provides the characteristics of each included study, including time frame, number of patients, and outcomes.
[Yes]
P19
[NA] - No assessment of risk of bias of individual studies was described.
P20
[NA] - No meta-analysis was performed.
P21
[NA] - No meta-analysis was performed.
P22
[NA] - No meta-analysis was performed.
P23
[NA] - No meta-analysis was performed.
P24
Quote: "Heterotaxy syndrome refers to abnormal arrangement of thoracoabdominal organs along the left-right body axis, and is associated with multiple congenital anomalies including complex congenital heart disease [4]. Previously reported to have up to 40% mortality, outcomes have improved in HS patients owing to refinements in surgical, anesthetic and critical care management [7,8]. IRA occurs in approximately 40–90% of HS patients [1]."
Reasoning: The discussion summarizes the main findings on the prevalence and outcomes of IRA in HS patients.
[Yes]
P25
Quote: "Despite the low risk of volvulus in the data presented here, there are anecdotal cases of patients with HS who presented with volvulus that resulted in death. At this time, it remains difficult to definitively ascertain whether the risk of death from prophylactic Ladd in HS or the risk of death from a volvulus in patients with HS who are observed is greater."
Reasoning: The authors discuss the limitations in definitively determining the risks of prophylactic Ladd vs observation based on the available data.
[Yes]
P26
Quote: "Ideally, a Ladd procedure should only be performed on those patients with HS that have the highest risk of volvulus, allowing the benefits of no operation to outweigh the risks."
Reasoning: The authors provide an interpretation that Ladd procedure should only be performed in high-risk HS patients, implying the need for future research to identify this subgroup.
[Yes]
P27
No relevant quotes found.
Reasoning: Sources of funding for the systematic review are not reported.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
NA
|
NA
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
0
|
1
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
NA
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
0
|
0
|
0
|
NA
|
NA
|
NA
|
NA
|
0
|
0
|
0
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
NA
|
NA
|
0
|
0
|
0
|
0
|
NA
|
NA
|
NA
|
0
|
0
|
0
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
NA
|
NA
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
0
|
0
|
0
|
0
|
0
|
0
|
NA
|
NA
|
NA
|
0
|
LLM response
6 quote(s) from
publication full text (mean similarity 100%)
A1:
"Circumcision is one of the most commonly performed operations [1], with various recognised techniques. Procedures include the Plastibell with ligature [2] and excision with or without suturing."
The research question and inclusion criteria were established before conducting the review.
[Yes]
A2:
No mention of duplicate study selection and data extraction.
[No]
A3:
No mention of number of databases searched, search terms used, or supplementary search strategies.
[No]
A4:
No mention of whether grey literature was searched or publication status was used as an inclusion criterion.
[No]
A5:
No list of included and excluded studies provided.
[No]
A6:
"In the last 20 years, surgeons have become increasingly interested in the use and application of adhesive bonds [4]. Tissue adhesives have been used in a number of medical applications, including traumatic lacerations, bronchopleu-ral fistula repair, intestinal anastomosis and middle ear surgery [5–7] and for closure of the skin wounds following"
Some characteristics of included studies like applications and outcomes were mentioned in aggregate form, but details like participant characteristics were lacking.
[No]
A7:
No mention of assessing methodological quality or risk of bias of included studies.
[No]
A8:
No assessment of study quality, so quality could not be used in formulating conclusions.
[NA]
A9:
No meta-analysis was conducted.
[NA]
A10:
No assessment of publication bias.
[NA]
A11:
No mention of conflict of interest or funding sources for the review or included studies.
[No]
P1:
"Paediatric sutureless circumcision: a systematic literature review"
Title identifies the report as a systematic review.
[Yes]
P2:
The abstract has labeled sections for background, technique, tissue glues, and outcomes, but is missing explicit objectives, data sources, study eligibility criteria, study appraisal and synthesis methods, results, limitations, conclusions and registration number.
[No]
P3:
"Circumcision is one of the most commonly performed operations [1], with various recognised techniques. Procedures include the Plastibell with ligature [2] and excision with or without suturing. Absorbable sutures have traditionally been used to approximate the skin edges."
Describes the rationale for the review in the context of circumcision being a common procedure with various techniques.
[Yes]
P4:
No explicit structured PICOS objectives provided.
[No]
P5:
No mention of a review protocol or registration number.
[No]
P6:
No explicit eligibility criteria in terms of PICOS provided.
[No]
P7:
No information provided on databases searched, date ranges, or date last searched.
[No]
P8:
No search strategy provided.
[No]
P9:
No description of the study selection process.
[No]
P10:
No description of the data extraction process.
[No]
P11:
No list of variables for which data were sought.
[No]
P12:
No description of assessing risk of bias in individual studies.
[No]
P13:
No summary measures specified.
[NA]
P14:
No meta-analysis conducted.
[NA]
P15:
No assessment of risk of bias across studies.
[NA]
P16:
No additional analyses described.
[NA]
P17:
No PRISMA flow diagram provided showing number of studies screened, assessed for eligibility, included and excluded with reasons.
[No]
P18:
Some study characteristics described narratively in the text, but no table of characteristics provided and citations not explicitly linked to descriptions.
[No]
P19:
No assessment of risk of bias of individual studies reported.
[No]
P20:
No results of individual studies presented.
[No]
P21:
No meta-analysis conducted.
[NA]
P22:
No assessment of risk of bias across studies.
[NA]
P23:
No additional analyses conducted.
[NA]
P24:
"In conclusion, sutureless circumcision in children appears to have significant advantages to the standard closure using interrupted sutures. As reported there are advantages that include a better postoperative appearance and parental satisfaction, reduced inflammation and infection rates and a reduced operative time."
Main findings are summarized, but strength of evidence for each outcome is not explicitly stated.
[No]
P25:
No discussion of limitations at the study, outcome, or review level.
[No]
P26:
"In conclusion, sutureless circumcision in children appears to have significant advantages to the standard closure using interrupted sutures. As reported there are advantages that include a better postoperative appearance and parental satisfaction, reduced inflammation and infection rates and a reduced operative time. The disadvantage is in the adolescent age group where tissue glue alone may not be an adequate form of closure due to the increased tension placed on the wound should the boys develop an erection. There is also a learning curve associated with the application of glue, but with experience a reproducible and reliable outcome should be expected."
Provides a general interpretation of the results in the context of other evidence and mentions implications for practice, but not future research.
[No]
P27:
No funding sources or role of funders described.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
1
|
NA
|
1
|
1
|
1
|
1
|
1
|
NA
|
NA
|
1
|
1
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
0
|
1
|
0
|
1
|
1
|
1
|
0
|
0
|
1
|
1
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
1
|
1
|
1
|
0
|
1
|
0
|
0
|
1
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
0
|
0
|
LLM response
26 quote(s) from
publication full text (mean similarity 98.6%)
A1
Quote: "We searched Medline, Embase, and Cochrane Trials databases for studies comparing open with endosurgical CDH repair."
Reasoning: The authors searched multiple databases based on pre-specified criteria for study inclusion.
[Yes]
A2
Quotes: "Two independent reviewers reviewed all studies in abstract form. Exclusions were only made at this point if it was absolutely clear that the above criteria were met. Full-text versions of the remaining studies were retrieved and corresponding authors were contacted for further information if necessary."
Reasoning: Study selection was done by two independent reviewers.
[Yes]
A3
Quote: "We searched Medline, Embase, and Cochrane Trials databases for studies comparing open with endosurgical CDH repair. Non-neonatal series and reports without comparison groups were excluded. References from eligible studies were also hand searched."
Reasoning: The authors searched 3 databases and checked references of included studies.
[Yes]
A4
Quote: "References from eligible studies were also hand searched."
Reasoning: The authors hand searched references, which includes grey literature.
[Yes]
A5
Quote: "Two independent reviewers reviewed all studies in abstract form. Exclusions were only made at this point if it was absolutely clear that the above criteria were met."
Reasoning: The authors state that studies were excluded at the abstract screening stage.
[No]
A6
Quote: "Analyzing the demographic data in each study, there were no statistically significant differences in proportion of male sex, mean birth weight, proportion of left-sided CDH, or proportion of cases with significant associated anomalies between open and endosurgical groups."
Reasoning: Demographic characteristics of the included studies were provided in aggregate form.
[Yes]
A7
Quote: "No randomized controlled trials were found. The 3 included studies compare open neonatal thoracoscopic and open CDH repairs performed at the same institutions. All are limited by their methodology, primarily due to the control (open surgery) groups being historical; there is therefore significant risk of case selection and performance bias."
Reasoning: The scientific quality of included studies was assessed and documented.
[Yes]
A8
Quote: "This meta-analysis illustrates that thoracoscopic neonatal CDH repair is currently associated with higher CDH recurrence risk and longer operative times compared with open CDH repair. Mortality and rate of prosthetic patch repair following open and thoracoscopic groups appears similar. However, these findings need to be considered in the context of the methodological limitations of the studies available for inclusion; for each outcome measure, we will discuss the potential for bias and other confounding factors."
Reasoning: The authors considered the quality of included studies when formulating conclusions.
[Yes]
A9
Quotes: "An intention to treat analysis was used, with cases converted to open surgery being retained in the endosurgical group. Demographic data was compared between groups in each study. Categorical data was analyzed with Fisher exact test, normally distributed data with a Student t test and nonparametric data with the Mann-Whitney U test. P ≤ 0.05 was regarded as significant."
"Meta-analysis was carried out using Review Manager (RevMan) Version 5.0 (The Nordic Cochrane Centre, The Cochrane Collaboration, 2008). Weighted treatment effect was calculated using the fixed effects model. Treatment effect is calculated and presented as relative risk (RR) for dichotomous variables and weighted mean difference (WMD) for continuous variables; along with 95% confidence intervals in each case."
Reasoning: Appropriate methods were used to combine findings of studies, including assessing for heterogeneity.
[Yes]
A10
Quote: "There were 6 (14.3%) conversions to open surgery in the endosurgical group of 2 of the studies. In the study of Cho et al and Gourlay et al, there was no mention of conversion to open surgery, but this was not included in the overall comparative study and the authors only report outcome data on successful thoracoscopic repairs."
Reasoning: This suggests publication bias was not assessed.
[No]
A11
The study does not mention sources of funding or conflicts of interest.
[No]
P1
Quote: "Neonatal Endosurgical Congenital Diaphragmatic Hernia Repair A Systematic Review and Meta-Analysis"
Reasoning: The title identifies the report as a systematic review and meta-analysis.
[Yes]
P2
The abstract is structured with labeled sections for Objective, Background, Methods, Results, and Conclusions.
[Yes]
P3
Quote: "Historically a surgical emergency, neonatal CDH repair is now deferred pending stabilization of characteristically labile cardiopulmonary physiology. Usually accomplished via laparotomy, surgical repair may acutely worsen lung function; conversely, by reducing the visceral hernia, surgery might improve it."
Reasoning: The introduction describes the rationale for the review in the context of what is already known.
[Yes]
P4
Quote: "To compare outcomes of open and endosurgical neonatal congenital diaphragmatic hernia (CDH) repair."
Reasoning: The objective statement specifies the question being addressed in terms of the population and intervention.
[Yes]
P5
The article does not mention a protocol or registration number.
[No]
P6
Quote: "Studies were eligible for inclusion in the review and meta-analysis if they directly compared open and endosurgical CDH repair in the newborn infant and included outcome data regarding survival, CDH recurrence, prosthetic patch use, and operative time."
Reasoning: Eligibility criteria are specified in terms of study characteristics and report characteristics.
[Yes]
P7
Quote: "MEDLINE (1950 to present), Embase (1980 to present) and Cochrane Controlled Trials Register databases were searched using the keywords 'diaphragmatic hernia AND thoracoscopic,' 'diaphragmatic hernia AND laparoscopic,' and 'diaphragmatic hernia AND minimally-invasive.' Relevant conference proceedings were also searched for abstracts of appropriate studies. Finally, citations of relevant full text reports were hand-searched for any additional studies. Duplicate studies were excluded at this point. The date of the last electronic search was 1st October 2009."
Reasoning: Information sources are described with dates of coverage and the search date.
[Yes]
P8
The full search strategy is not presented.
[No]
P9
Quote: "Two independent reviewers reviewed all studies in abstract form. Exclusions were only made at this point if it was absolutely clear that the above criteria were met. Full-text versions of the remaining studies were retrieved and corresponding authors were contacted for further information if necessary."
Reasoning: The process for selecting studies is described.
[Yes]
P10
Quote: "Data was extracted from the original study report or obtained directly from the corresponding author."
Reasoning: The data collection process is described.
[Yes]
P11
Quote: "Analyzing the demographic data in each study, there were no statistically significant differences in proportion of male sex, mean birth weight, proportion of left-sided CDH, or proportion of cases with significant associated anomalies between open and endosurgical groups."
Reasoning: The data items collected are defined.
[Yes]
P12
Quote: "No randomized controlled trials were found. The 3 included studies compare open neonatal thoracoscopic and open CDH repairs performed at the same institutions. All are limited by their methodology, primarily due to the control (open surgery) groups being historical; there is therefore significant risk of case selection and performance bias."
Reasoning: Risk of bias in individual studies was assessed.
[Yes]
P13
Quote: "Treatment effect is calculated and presented as relative risk (RR) for dichotomous variables and weighted mean difference (WMD) for continuous variables; along with 95% confidence intervals in each case."
Reasoning: The principal summary measures are stated.
[Yes]
P14
Quote: "Meta-analysis was carried out using Review Manager (RevMan) Version 5.0 (The Nordic Cochrane Centre, The Cochrane Collaboration, 2008). Weighted treatment effect was calculated using the fixed effects model."
Reasoning: The methods of combining results are described.
[Yes]
P15
The article does not mention assessing risk of bias across studies.
[No]
P16
The article does not describe any additional analyses.
[No]
P17
Quote: "The electronic search identified a total of 292 studies. Exclusions were made as detailed in the flow chart (Fig. 2). Search of conference proceedings yielded a further, unpublished study, resulting in 3 studies being incorporated in the meta-analysis."
Reasoning: A flow diagram is provided with the numbers of studies screened, assessed for eligibility, and included.
[Yes]
P18
The characteristics of each included study are not presented.
[No]
P19
Quote: "No randomized controlled trials were found. The 3 included studies compare open neonatal thoracoscopic and open CDH repairs performed at the same institutions. All are limited by their methodology, primarily due to the control (open surgery) groups being historical; there is therefore significant risk of case selection and performance bias."
Reasoning: Risk of bias for each study is presented.
[Yes]
P20
The results for individual studies are presented in the forest plots in Figure 3.
[Yes]
P21
The meta-analysis results are presented in the forest plots in Figure 3.
[Yes]
P22
The article does not present any assessment of risk of bias across studies.
[No]
P23
The article does not report any additional analyses.
[No]
P24
Quote: "This meta-analysis illustrates that thoracoscopic neonatal CDH repair is currently associated with higher CDH recurrence risk and longer operative times compared with open CDH repair. Mortality and rate of prosthetic patch repair following open and thoracoscopic groups appears similar."
Reasoning: The main findings are summarized.
[Yes]
P25
Quote: "However, these findings need to be considered in the context of the methodological limitations of the studies available for inclusion; for each outcome measure, we will discuss the potential for bias and other confounding factors."
Reasoning: Limitations at the study and outcome level are discussed.
[Yes]
P26
Quote: "Innovation is a key theme in the history and development of modern surgery. The proliferation of MIS has challenged the role of several open surgical techniques. However, adoption of, and evidential support for, MIS alternatives remains highly variable. Recently published IDEAL guidelines represent a consensus statement that seeks to provide a practical framework for the rigorous evaluation of surgical innovation."
Reasoning: A general interpretation is provided in the context of other evidence and implications for future research are discussed.
[Yes]
P27
The article does not describe sources of funding for the systematic review.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
0
|
0
|
0
|
1
|
0
|
0
|
0
|
NA
|
NA
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
1
|
0
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
0
|
0
|
0
|
NA
|
NA
|
NA
|
NA
|
1
|
0
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
NA
|
0
|
0
|
0
|
0
|
NA
|
NA
|
NA
|
0
|
0
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
0
|
0
|
0
|
0
|
1
|
1
|
NA
|
NA
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
0
|
1
|
0
|
0
|
0
|
1
|
1
|
NA
|
0
|
0
|
LLM response
16 quote(s) from
publication full text (mean similarity 100%)
Here is the assessment of the systematic review using AMSTAR and PRISMA:
A1
Quote: "The aim of the study was to review evidence-based data regarding the use of antibiotics for the treatment of appendicitis in children."
Reasoning: The research question was established a priori.
[Yes]
A2
Quotes: "We conducted a literature search using "appendicitis" combined with "antibiotics" with children as the target patient population. Studies were selected based on relevance for the following questions:"
Reasoning: At least two people selected studies, but no mention of duplicate data extraction or consensus process.
[No]
A3
Quotes: "PubMed and other databases of the English literature (up to August 2009) were analyzed. The Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, and the HTA Database were used as well. Appendicitis and antibiotics were selected as search terms, and the results were further narrowed as they related to the pediatric population."
Reasoning: At least two databases were searched along with other sources. Search terms are provided but not the full search strategy.
[Yes]
A4
Reasoning: No mention of including grey literature.
[No]
A5
Reasoning: No list of included and excluded studies provided.
[No]
A6
Reasoning: Some characteristics of included studies are provided in aggregate form, such as patient population and interventions, but details are limited.
[No]
A7
Quotes: "We classified each study according to the classes of evidence and rating of evidence as outlined in Fig. 1 [2]. Once guidelines were established, grades were assigned based on the strength of the studies supporting the recommendation [3]. Overall, 126 studies were selected and reviewed. However, we only referenced those studies with the highest class data that were most relevant to answering the questions listed above."
Reasoning: The scientific quality of included studies was assessed and documented using a grading system.
[Yes]
A8
Reasoning: The results section considers the quality of evidence in formulating conclusions, such as specifying "Grade A" or "Grade B" evidence.
[Yes]
A9
Reasoning: Not applicable as this is a systematic review without a meta-analysis.
[NA]
A10
Reasoning: Publication bias was not assessed.
[No]
A11
Reasoning: Sources of support for the systematic review are acknowledged, but not for each included study.
[No]
P1
Quote: "Antibiotics and appendicitis in the pediatric population: an American Pediatric Surgical Association Outcomes and Clinical Trials Committee Systematic Review"
Reasoning: The title identifies the article as a systematic review.
[Yes]
P2
Reasoning: The article has a structured abstract with labeled sections covering background, data sources, study selection, results, and conclusions.
[Yes]
P3
Quote: "Appendicitis is the most common surgical emergency in the pediatric population. Despite the widespread prevalence of the disease, there is little consensus regarding the diagnosis and management of appendicitis. In 2000, a survey of all members of the American Pediatric Surgical Association demonstrated controversy in virtually every aspect of the management of appendicitis [1]. With respect to antibiotic therapy, there was considerable variability in the choice, duration, and route of administration of antibiotics for both acute and perforated appendicitis."
Reasoning: The introduction describes the rationale for the review in the context of what is already known.
[Yes]
P4
Reasoning: The introduction states the questions being addressed, but does not explicitly reference the PICOS elements.
[No]
P5
Reasoning: No mention of a review protocol or registration number.
[No]
P6
Quotes: "Studies were selected based on relevance for the following questions:"
"Appendicitis and antibiotics were selected as search terms, and the results were further narrowed as they related to the pediatric population."
Reasoning: Some eligibility criteria are provided, but not specified in detail using PICOS.
[No]
P7
Quote: "PubMed and other databases of the English literature (up to August 2009) were analyzed. The Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, and the HTA Database were used as well."
Reasoning: Information sources are described but the date last searched is not provided.
[No]
P8
Reasoning: The full search strategy is not presented.
[No]
P9
Quote: "Overall, 126 studies were selected and reviewed. However, we only referenced those studies with the highest class data that were most relevant to answering the questions listed above."
Reasoning: The study selection process is described in brief but without full details.
[No]
P10
Reasoning: The data collection process is not described.
[No]
P11
Reasoning: Data items are not defined in detail. Some outcomes of interest are mentioned in the questions.
[No]
P12
Quotes: "We classified each study according to the classes of evidence and rating of evidence as outlined in Fig. 1 [2]. Once guidelines were established, grades were assigned based on the strength of the studies supporting the recommendation [3]."
Reasoning: A method of assessing risk of bias in individual studies is described.
[Yes]
P13
Reasoning: The principal summary measures are not explicitly stated.
[No]
P14
Reasoning: Not applicable as no meta-analysis was performed.
[NA]
P15
Reasoning: Risk of bias across studies was not assessed.
[No]
P16
Reasoning: No additional analyses were reported.
[NA]
P17
Reasoning: A flow diagram of study selection is not provided. The total number of studies reviewed is stated but without a breakdown of numbers at each stage.
[No]
P18
Reasoning: Characteristics of individual studies are not presented.
[No]
P19
Reasoning: Risk of bias assessments for individual studies are not presented.
[No]
P20
Reasoning: Results for individual studies are not fully reported with summary data and effect estimates.
[No]
P21
Reasoning: Not applicable as no meta-analysis was performed.
[NA]
P22
Reasoning: Not applicable as risk of bias across studies was not assessed.
[NA]
P23
Reasoning: Not applicable as no additional analyses were reported.
[NA]
P24
Quote: "Current evidence supports the use of guidelines as described above for antibiotic therapy in children with acute and perforated appendicitis."
Reasoning: The discussion summarizes the main findings but does not explicitly address the strength of evidence for each outcome.
[No]
P25
Reasoning: Limitations of the review are not discussed.
[No]
P26
Quote: "Further, broad-spectrum, single, or double agent therapy is as equally efficacious as but is more cost-effective than triple agent therapy."
Reasoning: The conclusion provides a general interpretation of the results in the context of other evidence and implications for practice.
[Yes]
P27
Quote: "Presented at the 2010 Annual Meeting of the American Pediatric Surgical Association, Orlando, Fla."
Reasoning: The funding source for the systematic review is not described, only that it was presented at a meeting.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
0
|
0
|
1
|
0
|
NA
|
NA
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
0
|
0
|
1
|
0
|
0
|
0
|
0
|
0
|
1
|
0
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
0
|
1
|
0
|
NA
|
NA
|
NA
|
NA
|
0
|
0
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
NA
|
0
|
1
|
0
|
0
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
0
|
0
|
0
|
1
|
0
|
0
|
NA
|
NA
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
0
|
0
|
0
|
0
|
1
|
1
|
1
|
NA
|
0
|
0
|
LLM response
19 quote(s) from
publication full text (mean similarity 93.9%)
A1
Quote: "This study aimed to review current practices in pediatric blunt renal trauma management and to highlight current practices in conservative management strategies, as well as short- and long-term outcomes of blunt renal trauma management."
Reasoning: The study objectives are clearly stated, indicating an a priori design.
[Yes]
A2
Quotes: "A search of all original research studies was conducted using PubMed, Ovid, and the Cochrane Library. The following search was performed in each of the three databases (Renal or Kidney) AND (Trauma AND Management. Publications were limited to publish date after January 1, 2000. Inclusion criteria were (1) original research articles regarding management of pediatric blunt renal trauma, (2) involvement of case of high- and Grade III and IV renal trauma, and (3) more than one patient presented per study."
Reasoning: The methods describe the search process but do not mention duplicate study selection or a consensus procedure for disagreements.
[No]
A3
Quotes: "A search of all original research studies was conducted using PubMed, Ovid, and the Cochrane Library. The following search was performed in each of the three databases (Renal or Kidney) AND (Trauma AND Management. Publications were limited to publish date after January 1, 2000."
Reasoning: At least 2 databases were searched with keywords provided, but no supplementary sources were mentioned.
[No]
A4
Quote: "Inclusion criteria were (1) original research articles regarding management of pediatric blunt renal trauma, (2) involvement of case of high- and Grade III and IV renal trauma, and (3) more than one patient presented per study."
Reasoning: Inclusion criteria are provided but publication status is not explicitly mentioned as a criterion.
[No]
A5
Quote: "A total of 32 articles met the selection criteria and were included in the review."
Reasoning: The number of included studies is provided but no list of excluded studies is given.
[No]
A6
Quote: "A total of 308 patients with urinary extravasation and 1,270 patients without urinary extravasation were included in the review (Table 2)."
Reasoning: Aggregate patient characteristics are provided in table form.
[Yes]
A7
Quote: "Cochrane risk of bias assessment tool—article bias."
Reasoning: A Cochrane risk of bias assessment was conducted on the included studies.
[Yes]
A8
Quote: "Although most studies did not report the duration of bed rest, typically, bed rest was maintained until resolution of gross hematuria."
Reasoning: The scientific quality was considered in formulating the conclusions.
[Yes]
A9
Reasoning: Quantitative synthesis of study results was not performed.
[NA]
A10
Reasoning: No assessment of publication bias was reported.
[No]
A11
Reasoning: Sources of funding for the systematic review and included studies are not reported.
[No]
P1
Quote: "Management of pediatric blunt renal trauma: A systematic review"
Reasoning: The title identifies the article as a systematic review.
[Yes]
P2
Quote: "This is a systematic review of PubMed, Ovid, and the Cochrane Library. The following search was performed in each of the three databases (Renal or Kidney) AND (Trauma AND Management. Publications were limited to publish date after January 1, 2000. Inclusion criteria were (1) original research articles regarding management of pediatric blunt renal trauma, (2) involvement of case of high- and Grade III and IV renal trauma, and (3) more than one patient presented per study. Literature reviews and meta-analyses were excluded."
Reasoning: The abstract provides a structured summary including objectives, data sources, study eligibility criteria, and study appraisal methods.
[Yes]
P3
Quote: "Blunt trauma remains a significant cause of morbidity and mortality in the pediatric population. The use of conservative management for blunt renal trauma is widely accepted in adult trauma literature and is now increasingly accepted for use in the pediatric patient population. This study aimed to review current practices in pediatric blunt renal trauma management and to highlight current practices in conservative management strategies, as well as short- and long-term outcomes of blunt renal trauma management."
Reasoning: The rationale for the review is described in the context of current knowledge.
[Yes]
P4
Quote: "This study aimed to review current practices in pediatric blunt renal trauma management and to highlight current practices in conservative management strategies, as well as short- and long-term outcomes of blunt renal trauma management."
Reasoning: The objectives are stated but do not explicitly reference the PICOS elements.
[No]
P5
Reasoning: No review protocol or registration information is mentioned.
[No]
P6
Quote: "Inclusion criteria were (1) original research articles regarding management of pediatric blunt renal trauma, (2) involvement of case of high- and Grade III and IV renal trauma, and (3) more than one patient presented per study."
Reasoning: The inclusion criteria specify the study characteristics used.
[Yes]
P7
Quote: "A search of all original research studies was conducted using PubMed, Ovid, and the Cochrane Library."
Reasoning: The information sources searched are listed but the dates of coverage and last search date are not provided.
[No]
P8
Reasoning: The full search strategy is not presented for any of the databases.
[No]
P9
Quote: "A total of 32 articles met the selection criteria and were included in the review (Table 2)."
Reasoning: The number of studies screened and included is provided but the full study selection process is not described.
[No]
P10
Reasoning: The data collection process is not described.
[No]
P11
Reasoning: The data items collected are not defined.
[No]
P12
Quote: "Cochrane risk of bias assessment tool—article bias."
Reasoning: Use of the Cochrane risk of bias tool for assessing individual studies is mentioned.
[Yes]
P13
Reasoning: The principal summary measures are not stated.
[No]
P14
Reasoning: No meta-analysis was performed.
[NA]
P15
Reasoning: Assessment of risk of bias across studies is not mentioned.
[No]
P16
Reasoning: No additional analyses are reported.
[NA]
P17
Quote: "A total of 32 articles met the selection criteria and were included in the review (Table 2)."
Reasoning: The number of included studies is provided but a full study selection flow diagram is not included.
[No]
P18
Quote: "Table 2. Characteristics of Studies Included in the Review"
Reasoning: Study characteristics and citations are provided in table format.
[Yes]
P19
Quote: "Cochrane risk of bias assessment tool—article bias."
Reasoning: A risk of bias assessment was performed but the results for each study are not presented.
[No]
P20
Reasoning: Results for individual studies are not provided.
[No]
P21
Reasoning: No meta-analysis was performed.
[NA]
P22
Reasoning: Risk of bias across studies was not assessed.
[NA]
P23
Reasoning: No additional analyses were reported.
[NA]
P24
Quote: "As management of high-grade renal injury trends toward conservative protocols, it is increasingly important to devise a pathway that optimizes recovery and minimizes length of stay and unnecessary intervention. There are currently no randomized control trials that assess the utility of ICU admission, urinary catheter drainage, antibiotics, bed rest, or routine imaging. Based on the findings of this review, there is minimal evidence to support routine ICU care for high-grade renal trauma patients. Patients should be maintained in the ICU based on daily assessment of monitoring needs."
Reasoning: The main findings and their relevance to key groups are summarized.
[Yes]
P25
Quote: "The review was limited by the retrospective nature of the studies included and the relatively small sample size because of the infrequency with which pediatric renal trauma occurs. Further limitations include the lack of uniformity in reporting timing of intervention, definition of failure of conservative therapy, and reasoning behind operative intervention."
Reasoning: Limitations at the review level are discussed.
[Yes]
P26
Quote: "As management of high-grade renal injury trends toward conservative protocols, it is increasingly important to devise a pathway that optimizes recovery and minimizes length of stay and unnecessary intervention. There are currently no randomized control trials that assess the utility of ICU admission, urinary catheter drainage, antibiotics, bed rest, or routine imaging. Based on the findings of this review, there is minimal evidence to support routine ICU care for high-grade renal trauma patients. Patients should be maintained in the ICU based on daily assessment of monitoring needs."
Reasoning: A general interpretation of the results and implications for future research are provided.
[Yes]
P27
Reasoning: Sources of funding for the systematic review are not reported.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
0
|
0
|
1
|
0
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
1
|
NA
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
1
|
0
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
NA
|
0
|
1
|
1
|
0
|
NA
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
1
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
1
|
0
|
0
|
0
|
1
|
1
|
1
|
1
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
0
|
1
|
0
|
0
|
1
|
1
|
1
|
NA
|
NA
|
0
|
LLM response
25 quote(s) from
publication full text (mean similarity 99%)
1
quote(s) from the LLM prompt briefing (mean similarity 100%) -
were instructions quoted (ok) or examples (unwanted beahviour)?
A1
Quote: "A search was made for studies published up until 31 August 2010 using the terms "lymphatic sparing varicocelectomy", "laparoscopy", "adolescent" and "children" in the Medline, Embase, Ovid, Web of Science, and Cochrane databases."
Reasoning: The research question and databases searched were specified a priori.
[Yes]
A2
No relevant quotes found.
Reasoning: No mention of duplicate study selection and data extraction.
[No]
A3
Quote: "A search was made for studies published up until 31 August 2010 using the terms "lymphatic sparing varicocelectomy", "laparoscopy", "adolescent" and "children" in the Medline, Embase, Ovid, Web of Science, and Cochrane databases. Randomized controlled trials (RCTs) and observational clinical studies (OCSs) comparing LSV and LNSV were included."
Reasoning: At least 2 databases were searched and key terms were provided.
[Yes]
A4
No relevant quotes found.
Reasoning: No mention of including grey literature.
[No]
A5
Quote: "Abstracts subsequently published as full text articles were excluded from this group to avoid counting results twice."
Reasoning: Excluded studies were referenced, but no list of included studies was provided.
[No]
A6
Quote: "In an aggregated form such as a table, data from the original studies should be provided on the participants, interventions and outcomes."
Reasoning: Table 1 provides a summary of the included studies with number of patients, age, and surgical indications.
[Yes]
A7
Quote: "Each included article was appraised by 3 reviewers (LZL, GJ and TQS), who independently assessed the methodological quality of the selected studies. A critical review checklist of the Dutch Cochrane Center was used to appraise the RCTs [de.cochrane.org, last updated Jul 2010]. This checklist was also considered valid for the assessment of the quality of non-RCTs."
Reasoning: A quality assessment was performed using a standard checklist.
[Yes]
A8
Quote: "LSV is valuable in reducing the incidence of postoperative hydrocele, with similar recurrence and catch-up growth rates as LNSV. A series of RCTs are warranted to explore the efficacy of LSV in the management of varicocele in children and adolescents."
Reasoning: The conclusions consider the quality assessment results.
[Yes]
A9
No relevant quotes found.
Reasoning: This was a systematic review without a meta-analysis, so assessing the appropriateness of combining studies is not applicable.
[NA]
A10
No relevant quotes found.
Reasoning: No assessment of publication bias was mentioned, likely because this was a systematic review without a meta-analysis.
[NA]
A11
Quote: "This work was supported by the National Natural Science Foundation of China (No. 30200284, No. 30600278, No. 30772359, No. 81071997, No. 81072073), Program for New Century Excellent Talents in the University of China (NCET-06-0641), the Scientific Research Foundation for Returned Overseas Chinese Scholars, State Education Ministry (2008-889), and Fundamental Research Funds for the Central Universities (2010JC025)."
Reasoning: Sources of funding for the systematic review were reported, but not for the individual studies.
[No]
P1
Quote: "Lymphatic Sparing Versus Lymphatic Non-Sparing Laparoscopic Varicocelectomy in Children and Adolescents: A Systematic Review and Meta-Analysis"
Reasoning: The title identifies the article as a systematic review and meta-analysis.
[Yes]
P2
Quote: See structured abstract on first page.
Reasoning: A structured abstract is provided with labeled sections for background, objective, methods, results, and conclusion.
[Yes]
P3
Quote: "Varicocele, an abnormal tortuosity and dilatation of the testicular vein within the spermatic cord, first develops in childhood or early adolescence [1]. The prevalence of varicocele in adolescent boys is estimated to be 11–15% [1]."
Reasoning: The introduction describes the rationale in the context of what is known about varicocele prevalence.
[Yes]
P4
Quote: "The aim of this study was to explore the true efficacy and potential advantages of lymphatic sparing laparoscopic varicocelectomy (LSV) over lymphatic non-sparing laparoscopic varicocelectomy (LNSV) in children and adolescents."
Reasoning: An explicit objective statement is provided referencing the population (children and adolescents) and intervention (LSV vs LNSV).
[Yes]
P5
No relevant quotes found.
Reasoning: No mention of a review protocol or registration number.
[No]
P6
Quote: "Eligibility criteria included all available studies comparing LSV with LNSV for varicocele repair in children and adolescents. Publications with evidence of possible overlap (e.g., same authors, institutions, period of study) of patients with other studies were discussed by LZL, GJ and TQS, and only the most recent or the most complete study was used."
Reasoning: Study eligibility criteria are described with rationale.
[Yes]
P7
Quote: "A search was made for studies published up until 31 August 2010 using the terms "lymphatic sparing varicocelectomy", "laparoscopy", "adolescent" and "children" in the Medline, Embase, Ovid, Web of Science, and Cochrane databases."
Reasoning: Databases searched and search date are provided.
[Yes]
P8
No relevant quotes found.
Reasoning: The full search strategy is not presented.
[No]
P9
Quote: "Abstracts subsequently published as full text articles were excluded from this group to avoid counting results twice."
Reasoning: The study selection process is described.
[Yes]
P10
Quote: "3 reviewers (LZL, GJ and TQS) independently assessed the selected studies, and extracted and tabulated data from each article using a predefined data extraction form."
Reasoning: Data extraction was done independently by reviewers using a predefined form.
[Yes]
P11
Quote: "Data for the following factors were considered: first author, publication date, study methodology, participant features, intervention characteristics, definition of complications, and outcome measures."
Reasoning: The data items collected are listed.
[Yes]
P12
Quote: "Each included article was appraised by 3 reviewers (LZL, GJ and TQS), who independently assessed the methodological quality of the selected studies. A critical review checklist of the Dutch Cochrane Center was used to appraise the RCTs [de.cochrane.org, last updated Jul 2010]. This checklist was also considered valid for the assessment of the quality of non-RCTs."
Reasoning: Risk of bias was independently assessed using a standard checklist.
[Yes]
P13
Quote: "ORs were used for the analysis of dichotomous variables. The CI was established at 95%."
Reasoning: Odds ratios and 95% confidence intervals were used as the main summary measures.
[Yes]
P14
No relevant quotes found.
Reasoning: This was a systematic review without a meta-analysis, so methods of combining results are not applicable.
[NA]
P15
No relevant quotes found.
Reasoning: No methods for assessing risk of bias across studies (e.g. publication bias) were mentioned, likely because no meta-analysis was performed.
[NA]
P16
Quote: "Meta-analysis is a statistical technique where the findings from independent studies are combined. This allows a comprehensive evaluation of the presence of heterogeneity [15]. The purpose of this study was to perform a systematic review and meta-analysis of the current literature to compare LSV and LNSV in the management of varicocele in children and adolescents."
Reasoning: Meta-analysis methods are described, but no additional analyses are specified.
[No]
P17
Quote: "127 studies were initially found reporting on the use of varicocelectomy in the management of varicocele in children and adolescents, using the keywords "varicocelectomy", "children" and "adolescent". 110 complete manuscripts and 24 as abstracts. After screening all titles and abstracts, the number of studies was reduced to 17 by limiting the inclusion criteria to "lymphatic sparing varicocelectomy", "laparoscopy", "children" and "adolescent". After an independent review, 7 publications which compared LSV and LNSV for the treatment of pediatric varicocele were considered to be eligible for inclusion in the analysis. One of these studies was subsequently excluded due to use of a combined microsurgical approach in children and adolescents [18], leaving 2 RCTs and 4 observational clinical studies (OCSs) for systematic review [10,14,19–22] (Fig. 1). A summary of the studies' methodology, intervention characteristics, and measured outcomes is provided in Table 1–3, including 489 cases of LSV and 307 cases of LNSV."
Reasoning: The number of studies screened, assessed, included and excluded are provided with reasons and a flow diagram.
[Yes]
P18
Quote: See Table 1.
Reasoning: Study characteristics are provided for each included study in Table 1.
[Yes]
P19
Quote: "Each included article was appraised by 3 reviewers (LZL, GJ and TQS), who independently assessed the methodological quality of the selected studies. A critical review checklist of the Dutch Cochrane Center was used to appraise the RCTs [de.cochrane.org, last updated Jul 2010]. This checklist was also considered valid for the assessment of the quality of non-RCTs."
Reasoning: Risk of bias was assessed for each study, but the individual study results are not presented.
[No]
P20
No relevant quotes found.
Reasoning: Simple summary data and effect estimates for each study are not provided, likely because no meta-analysis was performed.
[NA]
P21
No relevant quotes found.
Reasoning: No meta-analysis results are reported as this was a systematic review without meta-analysis.
[NA]
P22
No relevant quotes found.
Reasoning: Risk of bias across studies was not assessed, likely because no meta-analysis was performed.
[NA]
P23
No relevant quotes found.
Reasoning: No additional analyses were reported.
[NA]
P24
Quote: "LSV is valuable in reducing the incidence of postoperative hydrocele, with similar recurrence and catch-up growth rates as LNSV. A series of RCTs are warranted to explore the efficacy of LSV in the management of varicocele in children and adolescents."
Reasoning: The main findings are summarized with consideration of their relevance.
[Yes]
P25
Quote: "It has been reported that ultrasound is more precise than an orchiometer for the measurement of postoperative testicular volume, and scrotal ultrasound has become a routine part of the initial evaluation at most major centers [4]. Varicocele repair in children and adolescents can lead to catch-up growth and resolution of testicular asymmetry in 60–80% of patients [36,37]."
Reasoning: Some limitations are discussed at the review level regarding measurement techniques.
[Yes]
P26
Quote: "LSV is valuable in reducing the incidence of postoperative hydrocele, with similar recurrence and catch-up growth rates as LNSV. A series of RCTs are warranted to explore the efficacy of LSV in the management of varicocele in children and adolescents."
Reasoning: A general interpretation is provided in the context of the evidence with implications for future research.
[Yes]
P27
Quote: "This work was supported by the National Natural Science Foundation of China (No. 30200284, No. 30600278, No. 30772359, No. 81071997, No. 81072073), Program for New Century Excellent Talents in the University of China (NCET-06-0641), the Scientific Research Foundation for Returned Overseas Chinese Scholars, State Education Ministry (2008-889), and Fundamental Research Funds for the Central Universities (2010JC025)."
Reasoning: Sources of funding for the systematic review are described.
[Yes]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
0
|
0
|
1
|
1
|
1
|
1
|
1
|
0
|
1
|
0
|
1
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
1
|
1
|
0
|
0
|
1
|
1
|
1
|
1
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
0
|
LLM response
31 quote(s) from
publication full text (mean similarity 97.8%)
A1
Quote: "We conducted a systematic review and meta-analysis to review the currently available data comparing laparoscopic portoenterostomy (LPE) versus open portoenterostomy (OPE) for the treatment of biliary atresia (BA)."
Reasoning: The research question and inclusion criteria were established before conducting the review.
[Yes]
A2
Quotes: "Two investigators independently assessed selected studies and extracted data for meta-analysis." "All studies were single-center cohort studies and both cohorts, open versus laparoscopic, in all studies were performed by the same institution and same surgical teams."
Reasoning: At least two independent investigators selected studies and extracted data.
[Yes]
A3
Quotes: "We conducted a systematic search of the online databases, including Medline, Ovid, Elsevier, Google Scholar Embase, Cohrane library, for studies published between 1990 and 2014 with no limits for publication language, place of study origin and sample size of the studies." "The following Medical Subject Headings were used: ''comparative study,'' ''laparoscopy,'' ''biliary atresia,'' ''surgery,'' and ''treatment outcome''."
Reasoning: Multiple databases were searched using relevant keywords.
[Yes]
A4
Quote: "The following words were searched as text: ''laparoscopic portoenterostomy'', ''open portoenterostomy'', and ''biliary atresia''. Boolean operators (AND, OR = NOT) were additionally used to broaden or narrow the results of potentially usable studies."
Reasoning: The authors searched for reports regardless of publication type.
[Yes]
A5
Quote: "The process of study screening is showed in Fig. 1, through which, eleven studies assessing LPE versus OPE were considered suitable for meta-analysis, including two prospective [21, 22] and nine retrospective [13, 23–30] studies. Only one study was a randomized controlled trial, and the others were observational studies published between 2007 and 2012."
Reasoning: A list of included studies was provided.
[Yes]
A6
Quote: "The characteristics of these 11 studies are listed in Table 1."
Reasoning: Characteristics of included studies were provided in an aggregated table.
[Yes]
A7
Quote: "The Newcastle–Ottawa scale (NOS) for assessing the quality of included studies and is demonstrated in Table 3."
Reasoning: The quality of included studies was assessed using the Newcastle-Ottawa scale.
[Yes]
A8
Quote: "Without doubt, the number of the articles in this meta-analysis is small, which may cause the low survival rate in LPE patients. Possibly, caution should be applied and more cohort studies are needed before we reached a definite decision about long-term result between laparoscopic Kasai and open Kasai."
Reasoning: The authors considered the quality of included studies when formulating conclusions.
[Yes]
A9
Quotes: "The heterogeneity for summary effects was explored using the χ2 test, with significance set at P < 0.05, and was quantified using I2, with a maximum value of 50 % identifying low heterogeneity." "We also performed subgroup analysis to explore the possible sources of heterogeneity across studies. If the same patients were used for two different comparisons, we did a sensitivity analysis, and adjusted the weights according to the proportion of each group size."
Reasoning: Appropriate methods were used to assess and handle heterogeneity in the meta-analysis.
[Yes]
A10
The systematic review did not assess publication bias.
[NA]
A11
The systematic review did not report on conflicts of interest.
[No]
P1
Quote: "Laparoscopic portoenterostomy versus open portoenterostomy for the treatment of biliary atresia: a systematic review and meta-analysis of comparative studies"
Reasoning: The title identifies the article as a systematic review and meta-analysis.
[Yes]
P2
The abstract is structured with labeled sections for background, design, data sources, study selection, data extraction, results, and conclusion.
[Yes]
P3
Quote: "Open portoenterostomy (OPE) remains the mainstay in treatment of biliary atresia, while during the past several years, the laparoscopic portoenterostomy (LPE) has been widely introduced. However, safety of LPE remains a major concern. Thus, we conducted a systematic review and meta-analysis to review the currently available data comparing LPE and OPE."
Reasoning: The rationale for the review is described in the context of what is already known.
[Yes]
P4
The introduction does not provide an explicit statement of the review question being addressed in terms of PICOS.
[No]
P5
The article does not mention the existence of or access to a review protocol.
[No]
P6
Quote: "Before reviewing specific articles we defined criteria for the included studies. For inclusion in this meta-analysis, the studies had to meet the following criteria: (1) be a cohort study comparing laparoscopic technique and open technique in BA patients undergoing portoenterostomy; (2) include at least one primary or main outcome—hospital stay, operative time, blood loss, complications, early clearance of jaundice, the rate of long-term survival with native liver; (3) clearly document technique as ''laparoscopic'' or ''open''; (4) clearly document indications for portoenterostomy with biliary atresia; (5) be published as a full paper in a journal, not as meeting abstract or review."
Reasoning: Study characteristics and report characteristics used as eligibility criteria are specified.
[Yes]
P7
Quote: "We conducted a systematic search of the online databases, including Medline, Ovid, Elsevier, Google Scholar Embase, Cohrane library, for studies published between 1990 and 2014 with no limits for publication language, place of study origin and sample size of the studies."
Reasoning: Information sources and date ranges are described.
[Yes]
P8
Quote: "The following Medical Subject Headings were used: ''comparative study,'' ''laparoscopy,'' ''biliary atresia,'' ''surgery,'' and ''treatment outcome''. The following words were searched as text: ''laparoscopic portoenterostomy'', ''open portoenterostomy'', and ''biliary atresia''. Boolean operators (AND, OR = NOT) were additionally used to broaden or narrow the results of potentially usable studies."
Reasoning: The full search strategy is presented.
[Yes]
P9
Quote: "The process of study screening is showed in Fig. 1, through which, eleven studies assessing LPE versus OPE were considered suitable for meta-analysis, including two prospective [21, 22] and nine retrospective [13, 23–30] studies."
Reasoning: The study selection process is described.
[Yes]
P10
Quote: "Two investigators independently assessed selected studies and extracted data for meta-analysis."
Reasoning: The data collection process is described.
[Yes]
P11
The article does not explicitly list all variables for which data were sought.
[No]
P12
Quote: "The Newcastle–Ottawa scale (NOS) for assessing the quality of included studies and is demonstrated in Table 3."
Reasoning: The method for assessing risk of bias in individual studies is described.
[Yes]
P13
The article does not explicitly state the principal summary measures.
[No]
P14
Quotes: "The heterogeneity for summary effects was explored using the χ2 test, with significance set at P < 0.05, and was quantified using I2, with a maximum value of 50 % identifying low heterogeneity. In the presence of significant heterogeneity, pooled estimates of the ORs and MDs were calculated using a random-effects approach [20]." "We also performed subgroup analysis to explore the possible sources of heterogeneity across studies. If the same patients were used for two different comparisons, we did a sensitivity analysis, and adjusted the weights according to the proportion of each group size."
Reasoning: The methods for handling data and combining results are described, including measures of consistency.
[Yes]
P15
The article does not specify any assessment of risk of bias across studies.
[No]
P16
Quotes: "We also performed subgroup analysis to explore the possible sources of heterogeneity across studies." "We performed leave-one-out sensitivity analysis by excluding a study at a time and recalculating MDs (95 % CI) or ORs (95 % CI). There was no substantial change found in the pooled MDs (95 % CI) or ORs (95 % CI) during the overall analysis, suggesting the stability of our analysis."
Reasoning: Additional subgroup and sensitivity analyses are described.
[Yes]
P17
Quote: "The process of study screening is showed in Fig. 1, through which, eleven studies assessing LPE versus OPE were considered suitable for meta-analysis, including two prospective [21, 22] and nine retrospective [13, 23–30] studies."
Reasoning: The number of studies screened, assessed for eligibility, and included are provided, with reasons for exclusions shown in a flow diagram (Fig. 1).
[Yes]
P18
Quote: "The characteristics of these 11 studies are listed in Table 1."
Reasoning: Characteristics of included studies are presented in Table 1 along with citations.
[Yes]
P19
Quote: "The Newcastle–Ottawa scale (NOS) for assessing the quality of included studies and is demonstrated in Table 3."
Reasoning: Results of the risk of bias assessment for each study are presented in Table 3.
[Yes]
P20
Quotes: "Seven studies (Wada et al. [13], Nakamura et al [23], Diao et al. [25], Xu [21], Hou Wenying [28], Aspelund et al. [29], and Xuelai et al. [30]) contributed data (Table 1), including a total of 324 patients (134 in LPE, 190 in OPE). Two studies (Diao et al. [25] and Xuelai et al. [30]) showed the duration of operation was longer in the OPE group, while the other studies indicated operative time of LPE was longer." "Four trials (Diao et al. [25], Xu [21], Aspelund et al. [29], and Xuelai et al. [30]) reported the time of hospital stay (Table 1), including a total of 207 patients (83 in LPE, 124 in OPE). Evidence of significant heterogeneity was lacking (I2 = 0.77, I2 = 0 %). Then a fixed-effect model was adopted. Pooled mean difference (MD -0.76 days; 95 % CI -1.80 to 0.28 days; P = 0.15) stated no statistical difference (Fig. 3)."
Reasoning: For each study and outcome, summary data for each group and effect estimates with confidence intervals are presented.
[Yes]
P21
Quotes: "The present meta-analysis was performed according to the Quality of Reporting of Meta-analyses (QUORUM) guidelines and the recommendations of the Cochrane Collaboration [16–18]. For categorical variables data, statistical analysis was performed using the odds ratio (OR) as the statistic summary. This odds ratio represents the odds of an adverse event occurring in the LPE group compared with the OPE group. Statistical analysis for continuous variables was performed using the mean difference (MD) and as the summary statistic. If the mean differences (MD) were missing, we used means and ranges to estimate the MD, or we used the difference of medians to represent the difference of means [19]. The Mantel-Haenszel method was used to pool the ORs and MDs for the outcomes of interest. The confidence interval (CI) was established at 95 and P < 0.05 was considered to indicate statistical significance and an odds ratio of less than 1 favors the LPE group."
Reasoning: The results of each meta-analysis are presented, including confidence intervals and measures of consistency.
[Yes]
P22
The article does not present results of any assessment of risk of bias across studies.
[No]
P23
Quotes: "We also performed subgroup analysis to explore the possible sources of heterogeneity across studies." "We performed leave-one-out sensitivity analysis by excluding a study at a time and recalculating MDs (95 % CI) or ORs (95 % CI). There was no substantial change found in the pooled MDs (95 % CI) or ORs (95 % CI) during the overall analysis, suggesting the stability of our analysis."
Reasoning: The results of the additional subgroup and sensitivity analyses are provided.
[Yes]
P24
Quote: "The clinical impression is that BA patients who underwent LPE might have better early outcomes than patients in the OPE group. But in this meta-analysis, we found the difference was not statistically significant so LPE group was not better than OPE group in short-term outcomes like intraoperative blood loss, early clearance of jaundice and cholangitis. Of course, the results of our meta-analysis did not mean laparoscopic portoenterostomy had no use; LPE have the postulated advantages of less postoperative pain, faster recovery, and a better cosmetic result."
Reasoning: The main findings are summarized, including their relevance to key groups.
[Yes]
P25
Quote: "There are limitations to this review which must be considered. First, there have only been a small number of studies comparing LPE with OPE in the treatment of biliary atresia, with a lack of randomized trials. Second, the sample size of some selected studies is small so that the statistical power to detect the difference in the outcomes is limited. Third, although most of the comparative cohort studies seem to be robust, risk of selection bias still existed, as it was the surgeons' preference and experience that determined the allocation of patients to either LPE or OPE group. Fourth, marked heterogeneity for several meta-analysis, short follow-up time in some included studies, and the potentially existed significant risk of publication bias may more or less affect the accuracy of the results. Fifth, the other limitation is the length of follow-up. Our meta-analysis only compared native liver survival at 2 years post-Kasai and is, therefore, not possible to predict long-term survival (5–10 years) between LPE and OPE."
Reasoning: Limitations at the study, outcome, and review level are discussed.
[Yes]
P26
Quote: "Further improvements in the laparoscopic portoenterostomy are needed before its widespread application can be recommended."
Reasoning: A general interpretation is provided in the context of other evidence, with implications for future research.
[Yes]
P27
None declared.
[No]
PRISMA
|
|
P1
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P2
|
P3
|
P4
|
P5
|
P6
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P7
|
P8
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P9
|
P10
|
P11
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P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
0
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
1
|
0
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
0
|
NA
|
1
|
1
|
1
|
1
|
1
|
0
|
NA
|
1
|
0
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
NA
|
NA
|
1
|
1
|
1
|
0
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
1
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
0
|
0
|
1
|
1
|
1
|
NA
|
NA
|
0
|
LLM response
26 quote(s) from
publication full text (mean similarity 97.7%)
A1. Was an 'a priori' design provided?
Quote: "We conducted a structured search of Medline, Embase, trial registries, and the gray literature. We included studies that compared outcomes for FG and GJ in children with neurologic impairment."
The authors conducted a structured search based on pre-defined inclusion criteria.
[Yes]
A2. Was there duplicate study selection and data extraction?
Quote: "Title and abstract screening was completed independently and in duplicate by two of the authors (MHL, ACS). Disagreements resulted in automatic inclusion. Studies were included if participants were less than 18 years of age, had neurologic impairments, and a clinical history or investigation suggestive of gastroesophageal reflux."
Study selection was done in duplicate by two authors.
[Yes]
A3. Was a comprehensive literature search performed?
Quote: "We conducted a systematic search of Medline, Embase, and Cochrane Central Register of Controlled Trials for studies of participants with gastroesophageal reflux treated with FG or GJ. A medical librarian helped us develop queries for each database to identify studies that mentioned fundoplication and gastrojejunostomy."
The authors searched multiple databases and consulted a librarian.
[Yes]
A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion?
Quote: "We included studies that compared outcomes for FG and GJ in children with neurologic impairment."
The authors do not mention including grey literature or unpublished studies as an inclusion criterion.
[No]
A5. Was a list of studies (included and excluded) provided?
Quote: "The first article that was excluded following full text review was a qualitative study that explored quality-of-life issues among 8 children with neurologic impairment who underwent fundoplication and 8 who underwent GJ [33]. Several themes were identified using data obtained from all 16 participants, but no attempt was made to compare outcomes between these two groups."
The authors provide some details on one excluded study but do not provide a full list of included and excluded studies.
[No]
A6. Were the characteristics of the included studies provided?
Quote: "The three included studies reported on children and adolescents with gastroesophageal reflux and various forms of neurologic impairment. Some had progressive conditions but the majority had nonprogressive impairments (predominantly cerebral palsy and/or seizure disorders)."
The authors provide an aggregated description of the characteristics of included studies.
[Yes]
A7. Was the scientific quality of the included studies assessed and documented?
Quote: "None of the studies reached the gold standard cut-off on MINORS of 19.8 out of 24 (Table 2). All three used retrospective data and reported important baseline differences between treatment groups."
The authors used a validated tool (MINORS) to assess study quality and reported the scores.
[Yes]
A8. Was the scientific quality of the included studies used appropriately in formulating conclusions?
Quote: "Researchers should consider establishing large, comparative registries using observational data rather than dedicating significant resources to randomized controlled trials. Children with neurologic impairments and gastroesophageal reflux are medically complex, and many parents and clinicians are hesitant to proceed with randomization [35]."
The authors considered the low quality of evidence in formulating their conclusions and recommendations.
[Yes]
A9. Were the methods used to combine the findings of studies appropriate?
The authors did not perform a meta-analysis or quantitatively combine study findings.
[NA]
A10. Was the likelihood of publication bias assessed?
The authors did not assess publication bias, likely because there were only 3 included studies which is too few to reliably assess publication bias.
[NA]
A11. Was the conflict of interest included?
Quote: "Dr. Michael Livingston is supported by the Clinician Investigator Program at McMaster University, which is funded through the Ontario Ministry of Health and Long-term Care. Dr. Peter Rosenbaum is a Canada Research Chair in Childhood Disability Research, Mentoring, and Dissemination. These agencies had no role in selecting the topic or developing the content of this review."
The authors disclose their sources of support for conducting the systematic review. However, they do not report sources of funding for each included study.
[No]
P1. Title
Quote: "Fundoplication and gastrostomy versus percutaneous gastrojejunostomy for gastroesophageal reflux in children with neurologic impairment: A systematic review and meta-analysis"
The title identifies the article as a systematic review and meta-analysis.
[Yes]
P2. Abstract / Structured summary
The abstract has labeled sections covering background, methods, results, conclusions and other PRISMA-recommended elements.
[Yes]
P3. Introduction / Rationale
Quote: "Children with neurologic impairment often fail medical management of gastroesophageal reflux [1–4]. Even with maximal therapy, many patients continue to experience symptoms and complications."
The introduction describes the rationale for the review in the context of limitations of current therapies.
[Yes]
P4. Introduction / Objectives
Quote: "The radiologic option is a percutaneous gastrojejunostomy (GJ) [8]. This option is less invasive, requires less recovery time, and describes removal if symptoms of gastroesophageal reflux improve."
The introduction outlines the key question of comparing surgical fundoplication vs percutaneous gastrojejunostomy, though a formal PICOS statement is not provided.
[No]
P5. Methods / Protocol and registration
A review protocol and registration number are not mentioned.
[No]
P6. Methods / Eligibility criteria
Quote: "We included studies that compared outcomes for FG and GJ in children with neurologic impairment. We included the results from observational studies, graded the best available evidence, and focused on patient-important outcomes, including mortality, pneumonia, complications, and quality of life."
The eligibility criteria are described in terms of population, interventions, and outcomes.
[Yes]
P7. Methods / Information sources
Quote: "We conducted a systematic search of Medline, Embase, and Cochrane Central Register of Controlled Trials for studies of participants with gastroesophageal reflux treated with FG or GJ. A medical librarian helped us develop queries for each database to identify studies that mentioned fundoplication and gastrojejunostomy."
The databases searched and the role of a librarian are described.
[Yes]
P8. Methods / Search
Quote: "These concepts were expanded to include all relevant subject headings and text words, and combined using Boolean operators. We also performed manual searches of relevant journals, reference proceedings [13], theses and dissertations [14–16], and other trial registries [17–20]. We included all citations up until February 2014. No language limits were placed."
The full search strategy is not provided, but the concepts, manual searches, and lack of limits are described.
[No]
P9. Methods / Study selection
Quote: "Title and abstract screening was completed independently and in duplicate by two of the authors (MHL, ACS). Disagreements resulted in automatic inclusion. Studies were included if participants were less than 18 years of age, had neurologic impairments, and a clinical history or investigation suggestive of gastroesophageal reflux."
The process of screening titles/abstracts in duplicate is described.
[Yes]
P10. Methods / Data collection process
Quote: "We included all patient-important outcomes in our analysis. Outcomes deemed critical a priori were quality of life, all-cause mortality, and pneumonia. During the course of our review, we decided to add major complications as a critical outcome."
Data extraction is mentioned but the process is not described in detail (e.g. if done in duplicate).
[No]
P11. Methods / Data items
Quote: "We included all patient-important outcomes in our analysis. Outcomes deemed critical a priori were quality of life, all-cause mortality, and pneumonia. During the course of our review, we decided to add major complications as a critical outcome."
The outcomes of interest are described but other data items are not listed comprehensively.
[No]
P12. Methods / Risk of bias in individual studies
Quote: "Risk of bias for individual studies was assessed in duplicate using the methodological index for nonrandomized studies (MINORS). Differences between reviewers were resolved through consensus."
The use of the MINORS tool to assess risk of bias in duplicate is described.
[Yes]
P13. Methods / Summary measures
Summary measures are not explicitly stated, as no meta-analysis was performed.
[No]
P14. Methods / Synthesis of results
No meta-analysis was performed.
[NA]
P15. Methods / Risk of bias across studies
No assessment of risk of bias across studies (e.g. publication bias) is mentioned, likely because there were only 3 included studies.
[NA]
P16. Methods / Additional analyses
No additional analyses were reported.
[NA]
P17. Results / Study selection
Quote: "Fig. 1. Study selection using preferred reporting items for systematic reviews and meta-analyses (PRISMA) format [29]"
A PRISMA flow diagram is provided showing the number of studies at each stage of the selection process.
[Yes]
P18. Results / Study characteristics
Quote: "The three included studies reported on children and adolescents with gastroesophageal reflux and various forms of neurologic impairment. Some had progressive conditions but the majority had nonprogressive impairments (predominantly cerebral palsy and/or seizure disorders)."
Characteristics of the included studies are described in aggregate.
[Yes]
P19. Results / Risk of bias within studies
Quote: "None of the studies reached the gold standard cut-off on MINORS of 19.8 out of 24 (Table 2). All three used retrospective data and reported important baseline differences between treatment groups."
Results of the risk of bias assessment using MINORS are reported.
[Yes]
P20. Results / Results of individual studies
Quote: "In the same study, wrap failure following FG occurred in 14% (9/63) of participants. Seven of these children (11%) underwent redo fundoplication. By the end of the follow-up period, 25% (12/48) of children in the GJ group had their gastrojejunal feeding tubes removed, 8% (4/48) underwent FG, 2% (1/48) had the tube removed and were considering FG, 15% (7/48) of participants no longer required the gastrojejunal feeding tube because their ability to tolerate gastric feedings had improved."
Some individual study results are reported narratively, but simple summary data for each group and effect estimates are not provided.
[No]
P21. Results / Synthesis of results
No meta-analysis was performed.
[NA]
P22. Results / Risk of bias across studies
No assessment of risk of bias across studies is reported.
[NA]
P23. Results / Additional analysis
No additional analyses are reported.
[NA]
P24. Discussion / Summary of evidence
Quote: "The evidence supporting the use of FG versus GJ for refractory gastroesophageal reflux in children with neurologic impairment is very low. Studies reported to date have been complicated by baseline differences between treatment groups and imprecision due to small numbers."
The discussion summarizes the main findings and strength of evidence.
[Yes]
P25. Discussion / Limitations
Quote: "We found that the rates of mortality and pneumonia following either procedure are similar, and that most causes of death do not appear to be related to complications of treatment or ongoing gastroesophageal reflux. The risk of major complications appears to be higher with FG, whereas the risk of minor complications appears to be higher with GJ."
Some limitations of the evidence are discussed, including baseline differences between groups and imprecision.
[Yes]
P26. Discussion / Conclusions
Quote: "Researchers should consider establishing large, comparative registries using observational data rather than dedicating significant resources to randomized controlled trials. Children with neurologic impairments and gastroesophageal reflux are medically complex, and many parents and clinicians are hesitant to proceed with randomization [35]."
The authors provide conclusions in the context of the limitations and make recommendations for future research.
[Yes]
P27. Funding
Quote: "Dr. Michael Livingston is supported by the Clinician Investigator Program at McMaster University, which is funded through the Ontario Ministry of Health and Long-term Care. Dr. Peter Rosenbaum is a Canada Research Chair in Childhood Disability Research, Mentoring, and Dissemination. These agencies had no role in selecting the topic or developing the content of this review."
Sources of funding for the systematic review are reported.
[Yes]
PRISMA
|
|
P1
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P2
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P3
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P4
|
P5
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P6
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P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
1
|
NA
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
1
|
1
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
0
|
1
|
1
|
1
|
0
|
1
|
1
|
NA
|
1
|
1
|
1
|
1
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
1
|
0
|
0
|
0
|
1
|
1
|
1
|
1
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
1
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
0
|
LLM response
32 quote(s) from
publication full text (mean similarity 98.3%)
2
quote(s) from the LLM prompt briefing (mean similarity 100%) -
were instructions quoted (ok) or examples (unwanted beahviour)?
A1
Quotes: "This systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) statement."
Reasoning: The authors state they conducted the review according to PRISMA guidelines, but do not mention an a priori protocol.
[No]
A2
Quotes: "Titles and abstracts of all retrieved records, and subsequently full-text articles (that could potentially be included, or appeared potentially relevant), were examined independently by two authors (F.M. and B.B.) according to the PRISMA statement."
Reasoning: Study selection and data extraction were done independently by two authors.
[Yes]
A3
Quotes: "The same search strategy was used in EMBASE (replacing "[Title/Abstract]" by; "ti,ab" and "[MeSH Terms]" by/exp). Human, child and adolescent were used as search limits in both databases. In addition, the Cochrane Library was manually searched."
Reasoning: The authors searched PubMed, Embase, and the Cochrane Library, using search limits. The full search strategy is provided in Fig. 1.
[Yes]
A4
Quotes: "No language restrictions and time horizons were not applied"
Reasoning: The authors did not restrict by publication status or language.
[Yes]
A5
Quotes: "In total, 939 potentially relevant publications were identified. After title/abstract and full-text screening we selected eight original studies that met the inclusion and exclusion criteria"
Reasoning: The number of included and excluded studies at each stage is provided, but no list of excluded studies is given.
[No]
A6
Quotes: "For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations."
Reasoning: Key characteristics of the included studies, including population, interventions, outcomes, and follow-up duration are provided in Table 1.
[Yes]
A7
Quotes: "Using predefined criteria, two authors (F.M. and B.B) included studies and assessed their methodological quality and risk of bias according to the PRISMA statement and the Cochrane Collaboration's tool for risk of bias assessment."
Reasoning: The authors used predefined criteria to assess study quality and risk of bias.
[Yes]
A8
Quotes: "The overall methodological quality of included studies was generally poor."
Reasoning: The authors considered the poor methodological quality of the studies when interpreting the results.
[Yes]
A9
Quotes: "Meta-analysis could be performed on all primary outcomes, except for 24-h pH monitoring. None of the studies used standardized reflux questionnaires. Only the absence or presence of reflux symptoms was reported."
Reasoning: Meta-analysis was performed on all primary outcomes except 24-h pH monitoring. Heterogeneity was assessed.
[Yes]
A10
Quotes: "To identify possible selection bias funnel plots were constructed. The funnel plot on dysphagia indicated a lack of larger studies in favor of a partial fundoplication, but it is unclear whether this is due to publication bias or other mechanisms."
Reasoning: Funnel plots were used to assess publication bias, though they were inconclusive.
[Yes]
A11
Quotes: "F.A. Mauritz is supported by a Wilhelmina Children's Hospital grant. Authors F.A. Mauritz, B.A. Blomberg, R.K. Stellato, D.C. van der Zee, P.D. Siersema and M.Y.A. van Herwaarden-Lindeboom have no conflicts of interest or financial ties to disclose. Author F.A. Mauritz wrote the first draft of the manuscript and none of the authors was given an honorarium, grant, or other form of payment to produce the manuscript."
Reasoning: Sources of funding for the review are reported, but sources of support for the included studies are not mentioned.
[No]
P1
Quote: "Complete Versus Partial Fundoplication in Children with Gastroesophageal Reflux Disease: Results of a Systematic Review and Meta-analysis"
Reasoning: The title identifies the article as a systematic review and meta-analysis.
[Yes]
P2
Quote: "Abstract Complete fundoplication (Nissen) has long been accepted as the gold standard surgical procedure in children with therapy-resistant gastroesophageal reflux disease (GERD); however, increasingly more evidence has become available for partial fundoplication as an alternative. The aim of this study was to perform a systematic review and meta-analysis comparing complete versus partial fundoplication in children with therapy-resistant GERD. PubMed (1960 to 2011), EMBASE (from 1980 to 2011), and the Cochrane Library (issue 3, 2011) were systematically searched according to the PRISMA statement. Results were pooled in meta-analyses and expressed as risk ratios (RRs). In total, eight original trials comparing complete to partial fundoplication were identified. Seven of these studies had a retrospective study design. Short-term (RR 0.64; p=0.28) and long-term (RR 0.85; p=0.42) postoperative reflux control was similar for complete and partial fundoplication. Dysphagia occurred significantly more often after complete fundoplication (RR 2.56; p=0.007) than partial fundoplication. This systematic review and meta-analysis showed that reflux control is similar after both complete and partial fundoplication, while partial fundoplication significantly reduces the number of dilatations to treat severe dysphagia. However, because of the lack of a well-designed study, we have to be cautious in making definitive conclusions. To decide which type of fundoplication is the best practice in pediatric GERD patients, more randomized controlled trials comparing complete to partial fundoplication in children with GERD are warranted."
Reasoning: The abstract provides a structured summary including background, objectives, data sources, study eligibility criteria, participants and interventions, appraisal and synthesis methods, results, and conclusions.
[Yes]
P3
Quote: "Gastroesophageal reflux disease (GERD) in children is defined as pathologic gastroesophageal reflux causing symptoms, esophagus causing symptoms."
Reasoning: The introduction describes the rationale for the review in the context of what is known about GERD in children.
[Yes]
P4
Quote: "The aim of this study was to perform a systematic review and meta-analysis comparing complete versus partial fundoplication in children with therapy-resistant GERD."
Reasoning: The introduction provides an explicit statement of the review question being addressed.
[Yes]
P5
Reasoning: The authors do not mention if a review protocol exists or where it can be accessed.
[No]
P6
Quote: "Each article was independently assessed for eligibility using the following predefined criteria: - Study population: neurologically normal (NN) and impaired (NI) infants and children (0–18 years) undergoing primary antireflux surgery for GERD, irrespective of prior or concomitant gastrostomy placement. - Intervention: complete fundoplication documented as open or laparoscopic posterior 360° complete fundoplication, irrespective of division of the short gastric vessels and partial fundoplication as open or laparoscopic posterior (Toupet) or anterior (Thal or Watson) partial fundoplication. - Study outcomes: at least one of the outcome measures reported below. - Study design: originally published articles."
Reasoning: The methods section specifies the study characteristics and report characteristics used as criteria for eligibility.
[Yes]
P7
Quote: "This systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) statement. Using predefined search terms PubMed (1960 to 2011), EMBASE (from 1980 to 2011), and the Cochrane Library (issue 3, 2011) were systematically searched until March 16, 2011 to identify all articles comparing complete to partial fundoplication in children with GERD."
Reasoning: The methods describe the information sources searched and the dates of coverage.
[Yes]
P8
Quote: "The same search strategy was used in EMBASE (replacing "[Title/Abstract]" by; "ti,ab" and "[MeSH Terms]" by/exp). Human, child and adolescent were used as search limits in both databases. In addition, the Cochrane Library was manually searched."
Reasoning: The full electronic search strategy for PubMed is provided in Fig. 1, such that it could be repeated.
[Yes]
P9
Quote: "Titles and abstracts of all retrieved records, and subsequently full-text articles (that could potentially be included, or appeared potentially relevant), were examined independently by two authors (F.M. and B.B.) according to the PRISMA statement."
Reasoning: The study selection process is described.
[Yes]
P10
Quote: "Titles and abstracts of all retrieved records, and subsequently full-text articles (that could potentially be included, or appeared potentially relevant), were examined independently by two authors (F.M. and B.B.) according to the PRISMA statement."
Reasoning: Data extraction was performed independently by two authors.
[Yes]
P11
Quote: "Primary outcomes of interest were descriptive symptoms or standardized questionnaires on GERD, 24-h (with or without multichannel intraluminal impedance) pH monitoring, postoperative dysphagia and dilatations for dysphagia. Secondary outcomes of interest were surgical reinterventions (and reasons for reintervention), manometry, gastroscopy, inability to belch, gas bloat syndrome, quality of life, patient satisfaction, in-hospital complications, mortality, operating time and length of hospital stay. A follow-up time of less than 6 months was considered short-term follow up, while a follow-up time of more than 12 months was considered long-term follow-up."
Reasoning: The methods list and define all variables for which data were sought.
[Yes]
P12
Quote: "Using predefined criteria, two authors (F.M. and B.B) included studies and assessed their methodological quality and risk of bias according to the PRISMA statement and the Cochrane Collaboration's tool for risk of bias assessment."
Reasoning: The methods describe assessing risk of bias using the Cochrane risk of bias tool.
[Yes]
P13
Quote: "Results were presented as risk ratios (RRs) with 95 % confidence intervals (CI)."
Reasoning: Risk ratios were the principal summary measures.
[Yes]
P14
Quote: "Data were pooled using the Mantel–Haenszel random-effects meta-analysis model. The random-effects model was chosen to take into account suspected heterogeneity caused by differences in study design and patient population, as it generates a more conservative estimate than an analysis using the fixed-effects model."
Reasoning: The methods describe using a random-effects model for the meta-analysis.
[Yes]
P15
Quote: "To identify possible selection bias funnel plots were constructed. The funnel plot on dysphagia indicated a lack of larger studies in favor of a partial fundoplication, but it is unclear whether this is due to publication bias or other mechanisms."
Reasoning: Funnel plots were used to assess risk of bias across studies.
[Yes]
P16
Reasoning: The authors do not mention any additional analyses.
[No]
P17
Quote: "In total, 939 potentially relevant publications were identified. After title/abstract and full-text screening we selected eight original studies that met the inclusion and exclusion criteria"
Reasoning: The number of studies screened, assessed for eligibility, and included in the review are provided, with reasons for exclusions at each stage shown in a flow diagram (Fig. 1).
[Yes]
P18
Quote: "For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations."
Reasoning: Study characteristics and citations for the included studies are provided in Table 1.
[Yes]
P19
Quote: "The overall methodological quality of included studies was generally poor. All except one of the included studies used a retrospective cohort design. Only Kubiak et al. randomly allocated patients to either complete or partial fundoplication."
Reasoning: The results present data on the risk of bias within the included studies.
[Yes]
P20
Reasoning: Simple summary data for each intervention group and effect estimates with confidence intervals are not provided for each study for all outcomes. Some outcomes are reported this way in the forest plots, but not all.
[No]
P21
Quote: "Meta-analysis could be performed on all primary outcomes, except for 24-h pH monitoring."
Reasoning: Meta-analysis results with confidence intervals and measures of consistency are provided for the primary outcomes.
[Yes]
P22
Quote: "To identify possible selection bias funnel plots were constructed. The funnel plot on dysphagia indicated a lack of larger studies in favor of a partial fundoplication, but it is unclear whether this is due to publication bias or other mechanisms."
Reasoning: The results of the funnel plot assessment of publication bias are presented.
[Yes]
P23
Reasoning: No additional analyses are mentioned.
[NA]
P24
Quote: "This systematic review and meta-analysis showed that reflux control is similar after both complete and partial fundoplication, while partial fundoplication significantly reduces the number of dilatations to treat severe dysphagia."
Reasoning: The discussion summarizes the main findings and their relevance to key groups.
[Yes]
P25
Quote: "Finally, considering the trend shown in this systematic review in favor of Toupet fundoplication compared to Thal fundoplication, perhaps future research should particularly focus on investigating this specific type of fundoplication."
Reasoning: The authors discuss limitations at the study and outcome level (retrospective design) and review level (lack of well-designed studies).
[Yes]
P26
Quote: "To decide which type of fundoplication is the best practice in pediatric GERD patients, more randomized controlled trials comparing complete to partial fundoplication in children with GERD are warranted."
Reasoning: The authors provide a general interpretation of the results in the context of other evidence and implications for future research.
[Yes]
P27
Quote: "F.A. Mauritz is supported by a Wilhelmina Children's Hospital grant. Authors F.A. Mauritz, B.A. Blomberg, R.K. Stellato, D.C. van der Zee, P.D. Siersema and M.Y.A. van Herwaarden-Lindeboom have no conflicts of interest or financial ties to disclose. Author F.A. Mauritz wrote the first draft of the manuscript and none of the authors was given an honorarium, grant, or other form of payment to produce the manuscript."
Reasoning: Sources of funding and support for the systematic review are described, along with the role of the funders.
[Yes]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
NA
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
0
|
1
|
0
|
0
|
1
|
1
|
0
|
1
|
0
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
1
|
1
|
1
|
NA
|
NA
|
NA
|
NA
|
1
|
0
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
NA
|
NA
|
1
|
1
|
1
|
0
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
1
|
0
|
0
|
0
|
1
|
1
|
1
|
NA
|
NA
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
0
|
1
|
0
|
0
|
1
|
1
|
1
|
NA
|
NA
|
0
|
LLM response
19 quote(s) from
publication full text (mean similarity 98.8%)
A1 - Was an 'a priori' design provided?
Quote: "This article aims to systematically review the efficacy of pediatric ARS and its effects on gastroesophageal function tests."
Reasoning: The research objective was stated, but no mention of a protocol, ethics approval, or pre-determined inclusion criteria.
[No]
A2 - Was there duplicate study selection and data extraction?
Quote: "Each article was independently assessed for eligibility using the following criteria: study population—infants and children (0–18 years), who underwent ARS; type of intervention—open or laparoscopic Nissen, Thal, or Toupet fundoplication; study design—only prospective study format; study results—operative results reported using symptom questionnaires, or clearly defined reflux symptoms, or GE function tests, both before and after ARS."
Reasoning: Independent eligibility assessment was performed, but no mention of duplicate study selection or data extraction.
[No]
A3 - Was a comprehensive literature search performed?
Quote: "Three electronic databases (Medline, Embase, and the Cochrane Library) were searched for prospective studies reporting on ARS in children with GERD."
Reasoning: At least 2 databases plus reference checking were searched.
[Yes]
A4 - Was the status of publication (i.e. grey literature) used as an inclusion criterion?
Reasoning: No mention of including grey literature or unpublished studies.
[No]
A5 - Was a list of studies (included and excluded) provided?
Quote: "In total, 17 eligible studies were identified, reporting on a total of 1,280 children."
Reasoning: The number of included studies was stated, but no list of excluded studies was provided.
[No]
A6 - Were the characteristics of the included studies provided?
Quote: "Table 1 Details on included prospective clinical trials on ARS in children"
Reasoning: Characteristics of the included studies were provided in an aggregated table.
[Yes]
A7 - Was the scientific quality of the included studies assessed and documented?
Quote: "All potential threats to validity are summarized in Table 2."
Reasoning: The overall methodological quality was assessed and summarized.
[Yes]
A8 - Was the scientific quality of the included studies used appropriately in formulating conclusions?
Quote: "Our systematic review further shows that the quality of life has been highly underexposed in the evaluation of pediatric ARS, even though validated QoL questionnaires are available for different age groups and development levels."
Reasoning: The conclusions considered the limited quality of life evaluation in the included studies.
[Yes]
A9 - Were the methods used to combine the findings of studies appropriate?
Reasoning: This was a systematic review without a meta-analysis, so assessing the appropriateness of combining studies quantitatively is not applicable.
[NA]
A10 - Was the likelihood of publication bias assessed?
Reasoning: Publication bias was not assessed, likely because there were fewer than 10 included studies and no meta-analysis was performed.
[NA]
A11 - Was the conflict of interest included?
Reasoning: Conflicts of interest for the systematic review authors were stated, but the funding sources of the included studies were not reported.
[No]
P1 - Title: Identify the report as a systematic review, meta-analysis, or both.
Quote: "The Effects and Efficacy of Antireflux Surgery in Children with Gastroesophageal Reflux Disease: A Systematic Review"
Reasoning: The title identifies the article as a systematic review.
[Yes]
P2 - Abstract: Structured summary
Quote: The abstract contains labeled sections for Background, Methods, Results, and Conclusion.
Reasoning: A structured abstract with the required sections is provided.
[Yes]
P3 - Introduction: Rationale
Quote: "ARS is one of the most frequently performed major operations in children, and over the last decades, numerous studies have been published on this subject. The efficacy of ARS and the relationship between ARS and gastroesophageal (GE) function in children is difficult to deduce from these publications, since most studies are underpowered, retrospective, and have heterogeneous study designs, as well as a heterogeneous pediatric patient population."
Reasoning: The rationale for conducting the systematic review is described in the context of the limitations of existing studies.
[Yes]
P4 - Introduction: Objectives
Quote: "This article aims to systematically review the efficacy of pediatric ARS, this article aims to systematically review all prospective, longitudinal studies, and randomized controlled trials (RCTs). In addition, this review aims to study the effects of ARS on GE function in children, as measured by pre- and postoperative assessment tests."
Reasoning: The objectives are explicitly stated with reference to the target population, intervention, and outcomes.
[Yes]
P5 - Methods: Protocol and registration
Reasoning: No mention of a review protocol or registration.
[No]
P6 - Methods: Eligibility criteria
Quote: "Each article was independently assessed for eligibility using the following criteria: study population—infants and children (0–18 years), who underwent ARS; type of intervention—open or laparoscopic Nissen, Thal, or Toupet fundoplication; study design—only prospective study format; study results—operative results reported using symptom questionnaires, or clearly defined reflux symptoms, or GE function tests, both before and after ARS."
Reasoning: The eligibility criteria are specified with rationale.
[Yes]
P7 - Methods: Information sources
Quote: "Three electronic databases (Medline, Embase, and the Cochrane Library) were searched for prospective studies reporting on ARS in children with GERD."
Reasoning: The information sources are described but the dates of coverage and last search date are not provided.
[No]
P8 - Methods: Search
Reasoning: The full search strategy is not presented for any of the databases.
[No]
P9 - Methods: Study selection
Quote: "Each article was independently assessed for eligibility using the following criteria: study population—infants and children (0–18 years), who underwent ARS; type of intervention—open or laparoscopic Nissen, Thal, or Toupet fundoplication; study design—only prospective study format; study results—operative results reported using symptom questionnaires, or clearly defined reflux symptoms, or GE function tests, both before and after ARS."
Reasoning: The study selection process based on the eligibility criteria is described.
[Yes]
P10 - Methods: Data collection process
Quote: "The titles and abstracts of all identified studies were reviewed by two independent authors (WS, MH) according to the MOOSE criteria. Full publications were obtained for articles that appeared potentially relevant. References in these selected articles were also screened for cross-reference."
Reasoning: The data collection process involving two independent authors is described.
[Yes]
P11 - Methods: Data items
Reasoning: The specific variables for which data were sought are not defined.
[No]
P12 - Methods: Risk of bias in individual studies
Quote: "All potential threats to validity are summarized in Table 2."
Reasoning: The methods for assessing risk of bias in the included studies are described.
[Yes]
P13 - Methods: Summary measures
Reasoning: The main summary measures are not explicitly stated.
[No]
P14 - Methods: Synthesis of results
Reasoning: No meta-analysis was performed, so this item is not applicable.
[NA]
P15 - Methods: Risk of bias across studies
Reasoning: No meta-analysis was performed, so this item is not applicable.
[NA]
P16 - Methods: Additional analyses
Reasoning: No meta-analysis was performed, so this item is not applicable.
[NA]
P17 - Results: Study selection
Quote: "In total, 1,260 articles were identified and screened. Of these, 17 original prospective studies that met our criteria were selected for inclusion (Fig. 1)."
Reasoning: The number of studies screened, assessed for eligibility, and included are provided with reasons for exclusions at each stage and a flow diagram (Figure 1).
[Yes]
P18 - Results: Study characteristics
Quote: "Table 1 Details on included prospective clinical trials on ARS in children"
Reasoning: The characteristics of the included studies are presented with citations in Table 1.
[Yes]
P19 - Results: Risk of bias within studies
Quote: "All potential threats to validity are summarized in Table 2."
Reasoning: The risk of bias assessments for the included studies are presented.
[Yes]
P20 - Results: Results of individual studies
Reasoning: The results for each individual study are not presented. Only overall ranges across studies are reported.
[No]
P21 - Results: Synthesis of results
Reasoning: No meta-analysis was performed, so this item is not applicable.
[NA]
P22 - Results: Risk of bias across studies
Reasoning: No meta-analysis was performed, so this item is not applicable.
[NA]
P23 - Results: Additional analysis
Reasoning: No meta-analysis was performed, so this item is not applicable.
[NA]
P24 - Discussion: Summary of evidence
Quote: "Our systematic review identified more than 1,000 publications after searching the available databases for pediatric ARS. Most of these articles were found to be retrospective studies or case reports. Only 17 prospective, longitudinal studies, using reflux symptom scores and/or GE tests could be identified that described the outcome of ARS in pediatric GERD patients. This indicates that the vast majority of studies on pediatric ARS are of poor quality."
Reasoning: The main findings are summarized, including the strength of evidence based on study designs.
[Yes]
P25 - Discussion: Limitations
Quote: "Our systematic review further shows that the quality of life has been highly underexposed in the evaluation of pediatric ARS, even though validated QoL questionnaires are available for different age groups and development levels."
Reasoning: Some limitations at the review level regarding quality of life assessment are discussed.
[Yes]
P26 - Discussion: Conclusions
Quote: "In conclusion, ARS in children shows a good overall success rate (median 86%) in terms of complete relief of symptoms. The success rate in NI patients may not be worse compared to NN patients. The outcome of ARS does not seem to be influenced by different surgical techniques, although postoperative dysphagia may occur less after partial fundoplication. The strength of these conclusions is, however, bound by the lack of high-quality prospective studies on pediatric ARS."
Reasoning: The conclusions provide a general interpretation of the results in the context of the evidence and note implications for future research.
[Yes]
P27 - Funding
Reasoning: The funding sources for the systematic review are not described.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
1
|
0
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
0
|
1
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
1
|
NA
|
1
|
1
|
0
|
1
|
1
|
1
|
NA
|
1
|
0
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
NA
|
1
|
1
|
0
|
0
|
1
|
0
|
NA
|
1
|
1
|
1
|
1
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
1
|
1
|
0
|
0
|
1
|
1
|
0
|
0
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
0
|
0
|
LLM response
23 quote(s) from
publication full text (mean similarity 95.3%)
A1
Quotes: "Because the current study was a systematic review and meta-analysis based on the published articles, the consents of patients and approval of Institutional Review Boards were not included."
Reasoning: The authors did not mention an a priori protocol or pre-determined objectives.
[No]
A2
Quotes: "Two reviewers (MH and TQS) independently assessed selected studies, and tabulated data from each article with a predefined data extraction form."
Reasoning: Study selection and data extraction were done independently by two reviewers.
[Yes]
A3
Quotes: "We searched online databases, including Medline (using PubMed as the search engine), Embase, Web of Science, Ovid, and Cochrane, to identify suitable studies until the end of October 2010, without lower date limit."
Reasoning: Multiple databases were searched without date restrictions.
[Yes]
A4
Quotes: None relevant.
Reasoning: The inclusion of grey literature was not mentioned.
[No]
A5
Quotes: "Potentially relevant abstracts captured and screened (n=1403)", "Articles included in the meta-analysis (n=9)"
Reasoning: A flow diagram was provided showing the number of included and excluded studies.
[Yes]
A6
Quotes: "One RCT, two prospective comparative studies, and six retrospective observational studies were eligible for inclusion criteria and selected for this analysis, comprising 694 cases of LP and 7334 cases of OP."
Reasoning: Aggregate characteristics of the included studies were provided.
[Yes]
A7
Quotes: "Each included study was appraised by two reviewers (MH and TQS), who assessed the methodologic quality of selected studies independently. A critical review checklist of the Dutch Cochrane Centre was used to appraise the RCTs (de.cto chrane.org, last updated Jul 2010). This checklist was also considered valid to assess the quality of non-RCTs."
Reasoning: The methodological quality of included studies was independently assessed using a checklist.
[Yes]
A8
Quotes: "LP is a minimally invasive, safe, and effective therapy method for UPJ obstruction in children, with shorter hospital stay and excellent outcomes, and without additional risk of postoperative complications. Because of the publishing bias, a series of RCTs are necessary to confirm the efficacies and potential advantages of LP in relation to conventional OP in the treatment of children with UPJ obstructions."
Reasoning: The quality assessment was considered when formulating the conclusions.
[Yes]
A9
Quotes: "Meta-analyses were performed for the five primary outcome parameters. Operative time (in minutes), postoperative complications (in events per group), duration of hospital stay (in days), success rate (in events per group), and stenting rate (in events per group)."
Reasoning: Meta-analyses were appropriately conducted for multiple outcomes.
[Yes]
A10
Quotes: "Because of the publishing bias, a series of RCTs are necessary to confirm the efficacies and potential advantages of LP in relation to conventional OP in the treatment of children with UPJ obstructions."
Reasoning: Publication bias was mentioned as a limitation but not formally assessed.
[No]
A11
Quotes: None relevant.
Reasoning: Sources of funding and conflicts of interest were not reported.
[No]
P1
Quotes: "Laparoscopic Versus Open Pyeloplasty for Ureteropelvic Junction Obstruction in Children: A Systematic Review and Meta-Analysis"
Reasoning: The title identifies the article as a systematic review and meta-analysis.
[Yes]
P2
Quotes: The abstract contains structured sections for Purpose, Materials and Methods, Results, and Conclusions.
Reasoning: A structured abstract with the required sections is provided.
[Yes]
P3
Quotes: "Although the laparoscopic approach has developed worldwide and become a preferred method for UPJ obstruction repair, particularly in adults, it has not yet reached the degree of popularity among pediatric urologists."
Reasoning: The rationale for the review is described in the context of what is already known.
[Yes]
P4
Quotes: "Purpose: To comprehensively review the available evidences in the literature on the use of laparoscopic pyeloplasty (LP) as open pyeloplasty (OP) for the repair of ureteropelvic junction (UPJ) obstruction in children."
Reasoning: The purpose statement specifies the review question in terms of the PICOS elements.
[Yes]
P5
Quotes: None relevant.
Reasoning: No mention of a review protocol or registration number.
[No]
P6
Quotes: "Because of the paucity of available evidence that addressed the study question, our search was not restricted to randomized controlled trials (RCTs). Controlled clinical trials and comparative studies (including case-matched studies) were included as well. Although no language restrictions were imposed initially, the search was limited to studies published in the English language for the full-text review and final analysis."
Reasoning: The eligibility criteria in terms of study designs and language were specified.
[Yes]
P7
Quotes: "We searched online databases, including Medline (using PubMed as the search engine), Embase, Web of Science, Ovid, and Cochrane, to identify suitable studies until the end of October 2010, without lower date limit."
Reasoning: The information sources searched and dates of coverage were described.
[Yes]
P8
Quotes: None relevant.
Reasoning: The full search strategy was not provided for any of the databases.
[No]
P9
Quotes: "Two reviewers (MH and TQS) independently assessed selected studies, and tabulated data from each article with a predefined data extraction form."
Reasoning: The process of study selection was described.
[Yes]
P10
Quotes: "Two reviewers (MH and TQS) independently assessed selected studies, and tabulated data from each article with a predefined data extraction form."
Reasoning: The data collection process was described.
[Yes]
P11
Quotes: "Data regarding the following items were extracted: study characteristics, participant features, intervention characteristics, definition of complications, and outcome measures."
Reasoning: The data items collected were described.
[Yes]
P12
Quotes: "Each included study was appraised by two reviewers (MH and TQS), who assessed the methodologic quality of selected studies independently. A critical review checklist of the Dutch Cochrane Centre was used to appraise the RCTs (de.cto chrane.org, last updated Jul 2010). This checklist was also considered valid to assess the quality of non-RCTs."
Reasoning: The methods for assessing risk of bias in individual studies were described.
[Yes]
P13
Quotes: None relevant.
Reasoning: The principal summary measures were not explicitly stated.
[No]
P14
Quotes: "Meta-analyses were performed for the five primary outcome parameters. Operative time (in minutes), postoperative complications (in events per group), duration of hospital stay (in days), success rate (in events per group), and stenting rate (in events per group)."
Reasoning: The methods of combining results in the meta-analysis were described.
[Yes]
P15
Quotes: "Because of the publishing bias, a series of RCTs are necessary to confirm the efficacies and potential advantages of LP in relation to conventional OP in the treatment of children with UPJ obstructions."
Reasoning: Risk of bias across studies was mentioned as a limitation but not formally assessed.
[No]
P16
Quotes: None relevant.
Reasoning: No additional analyses were mentioned.
[NA]
P17
Quotes: Figure 1 shows a flow diagram of study selection with reasons for exclusions at each stage.
Reasoning: A flow diagram of study selection was provided.
[Yes]
P18
Quotes: Table 1 presents the characteristics of the included studies with citations.
Reasoning: The characteristics of each included study were presented with citations.
[Yes]
P19
Quotes: None relevant.
Reasoning: Risk of bias assessments for each study were not presented.
[No]
P20
Quotes: None relevant.
Reasoning: Results were not presented for each study individually.
[No]
P21
Quotes: The results of the meta-analyses are presented in Tables 2-4 and Figures 2-6.
Reasoning: The meta-analysis results were reported with confidence intervals and measures of consistency.
[Yes]
P22
Quotes: None relevant.
Reasoning: The results of the risk of bias assessment across studies were not reported.
[No]
P23
Quotes: None relevant.
Reasoning: No additional analyses were reported.
[NA]
P24
Quotes: "LP is a minimally invasive, safe, and effective therapy method for UPJ obstruction in children, with shorter hospital stay and excellent outcomes, and without additional risk of postoperative complications."
Reasoning: The main findings were summarized.
[Yes]
P25
Quotes: "Because of the publishing bias, a series of RCTs are necessary to confirm the efficacies and potential advantages of LP in relation to conventional OP in the treatment of children with UPJ obstructions."
Reasoning: Limitations related to publication bias were discussed.
[Yes]
P26
Quotes: "Because of the limited data in included studies, however, the comparison of cost between LP and OP was not performed in this meta-analysis. We believe that stent placement is an important variable to report for the LP procedure, especially when costs and morbidity are considered."
Reasoning: The conclusions provided a general interpretation and implications for future research.
[Yes]
P27
Quotes: "This work was supported by the National Natural Science Foundation of China (No. 30200284, No. 30600278, No. 30772359, No. 81071997, No. 81072073), Program for New Century Excellent Talents in University (NCET-06-0641), Scientific Research Foundation for the Returned Overseas Chinese Scholars (2008-889), and Fundamental Research Funds for the Central Universities (2010JC025)."
Reasoning: Sources of funding for the systematic review were described.
[Yes]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
NA
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
1
|
1
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
NA
|
NA
|
1
|
1
|
1
|
0
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
1
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
NA
|
NA
|
0
|
LLM response
19 quote(s) from
publication full text (mean similarity 99%)
39 quote(s)
from the LLM prompt briefing (mean similarity 99.7%) - were
instructions quoted (ok) or examples (unwanted beahviour)?
Here is the assessment of the systematic review using AMSTAR and PRISMA:
AMSTAR:
A1. "The research question and inclusion criteria should be established before the conduct of the review."
[Yes] The objectives and selection criteria were pre-specified in the Methods section.
A2. "There should be at least two independent data extractors and a consensus procedure for disagreements should be in place."
"Two authors independently searched the literature, determined study eligibility, assessed quality, extracted and entered data."
[Yes] Data extraction was done in duplicate by two authors independently.
A3. "At least two electronic sources should be searched" [...] " supplemented by consulting current contents, reviews, textbooks, specialized registers, or experts in the particular field of study, and by reviewing the references in the studies found."
"In August 2010 we searched CENTRAL, MEDLINE and EMBASE and screened reference lists of papers and abstracts from conference proceedings."
[Yes] At least 2 databases were searched and supplemented by checking reference lists and conference proceedings.
A4. "The authors should state that they searched for reports regardless of their publication type. The authors should state whether or not they excluded any reports (from the systematic review), based on their publication status, language etc."
[No] No mention of searching for grey literature or unpublished studies.
A5. "A list of included and excluded studies should be provided."
"We originally identified 10 studies after full paper assessment (Wheeler 2004). The International Reflux Study was reported in a European arm (IRS EUR 1981-2003) and an American arm (IRS USA 1992) and so we treated them as two separate studies."
[Yes] The included studies are listed. Excluded studies are referenced in Figure 1.
A6. "In an aggregated form such as a table, data from the original studies should be provided on the participants, interventions and outcomes."
[Yes] Characteristics of included studies are provided in an ordered table.
A7. "'A priori' methods of assessment should be provided (e.g., for effectiveness studies if the author(s) chose to include only randomized, double-blind, placebo controlled studies, or allocation concealment as inclusion criteria); for other types of studies alternative items will be relevant."
"The following items will be independently assessed by two authors using the risk of bias assessment tool (Higgins 2008) (see Appendix 2): • Was there adequate sequence generation? • Was allocation adequately concealed? • Was knowledge of the allocated interventions adequately prevented during the study? • Were incomplete outcome data adequately addressed? • Are reports of the study free of suggestion of selective outcome reporting? • Was the study apparently free of other problems that could put it at a risk of bias?"
[Yes] The risk of bias assessment methods are described a priori.
A8. "The results of the methodological rigor and scientific quality should be considered in the analysis and the conclusions of the review, and explicitly stated in formulating recommendations."
"The quality of conduct and reporting of these studies was variable, with many studies omitting crucial methodological information used to assess the risk of bias."
[Yes] The limitations of study quality are considered in the conclusions.
A9. "For the pooled results, a test should be done to ensure the studies were combinable, to assess their homogeneity (i.e., Chi-squared test for homogeneity, I2). If heterogeneity exists a random effects model should be used and/or the clinical appropriateness of combining should be taken into consideration (i.e., is it sensible to combine?)."
[NA] No meta-analysis was performed.
A10. "An assessment of publication bias should include a combination of graphical aids (e.g., funnel plot, other available tests) and/or statistical tests (e.g., Egger regression test, Hedges-Olken)."
[NA] No meta-analysis was performed.
A11. "Potential sources of support should be clearly acknowledged in both the systematic review and the included studies."
"Australian Kidney Foundation, Seeding Grant number S2/99, Australia."
[No] Sources of funding are reported for the systematic review but not for the individual studies.
PRISMA:
P1. "Identify the report as a systematic review, meta-analysis, or both."
"Interventions for primary vesicoureteric reflux"
[Yes] The title identifies the article as a systematic review of interventions.
P2. "Provide a structured summary including, as applicable: background; objectives; data sources; study eligibility criteria, participants, and interventions; study appraisal and synthesis methods; results; limitations; conclusions and implications of key findings; systematic review registration number."
[Yes] The abstract contains the required structured sections.
P3. "Describe the rationale for the review in the context of what is already known."
"Vesicoureteric reflux (VUR) results in urine passing retrograde up the ureter. Urinary tract infections (UTI) associated with VUR have been considered a cause of permanent renal parenchymal damage in children with VUR. Management of these children has been directed at preventing UTI by antibiotic prophylaxis and/or surgical correction of VUR. The optimum strategy is not clear."
[Yes] The background provides context and rationale for the review.
P4. "Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS)."
"To evaluate the benefits and harms of different treatment options for primary VUR."
[Yes] The objectives are stated, though not in full PICOS format.
P5. "Indicate if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provide registration information including registration number."
"Protocol first published: Issue 2, 1999 Review first published: Issue 3, 2004"
[Yes] The protocol is referenced.
P6. "Specify study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale."
"RCTs in any language comparing any treatment of VUR including surgical or endoscopic correction, antibiotic prophylaxis, non-invasive non-pharmacological techniques and any combination of therapies."
[Yes] The eligibility criteria are specified.
P7. "Describe all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched."
"In August 2010 we searched CENTRAL, MEDLINE and EMBASE and screened reference lists of papers and abstracts from conference proceedings."
[Yes] The information sources and last search date are reported.
P8. "Present full electronic search strategy for at least one database, including any limits used, such that it could be repeated."
[No] The full search strategies are not provided.
P9. "State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta-analysis)."
"Two authors independently searched the literature, determined study eligibility, assessed quality, extracted and entered data."
[Yes] The study selection process is described.
P10. "Describe method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators."
"Data extraction was conducted independently by at least two authors, using a standardised data extraction form. All studies, reported in a non-English journal, were translated prior to assessment."
[Yes] The data extraction methods are described.
P11. "List and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made."
[No] The variables for data extraction are not explicitly defined.
P12. "Describe methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis."
"The following items will be independently assessed by two authors using the risk of bias assessment tool (Higgins 2008) (see Appendix 2): • Was there adequate sequence generation? • Was allocation adequately concealed? • Was knowledge of the allocated interventions adequately prevented during the study? • Were incomplete outcome data adequately addressed? • Are reports of the study free of suggestion of selective outcome reporting? • Was the study apparently free of other problems that could put it at a risk of bias?"
[Yes] The risk of bias assessment methods are described in detail.
P13. "State the principal summary measures (e.g., risk ratio, difference in means)."
[NA] No meta-analysis was performed.
P14. "Describe the methods of handling data and combining results of studies, if done, including measures of consistency (e.g., I2) for each meta-analysis."
[NA] No meta-analysis was performed.
P15. "Specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies)."
[NA] No meta-analysis was performed.
P16. "Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre-specified."
[NA] No additional analyses were performed.
P17. "Give numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram."
[Yes] The study flow diagram is provided in Figure 1.
P18. "For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations."
[Yes] The characteristics of included studies are provided in an ordered table.
P19. "Present data on risk of bias of each study and, if available, any outcome level assessment (see item 12)."
[Yes] The risk of bias assessments are presented in Figure 2 and Figure 3.
P20. "For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot."
[No] Summary data and effect estimates are not provided for each study.
P21. "Present results of each meta-analysis done, including confidence intervals and measures of consistency."
[NA] No meta-analysis was performed.
P22. "Present results of any assessment of risk of bias across studies (see Item 15)."
[NA] No meta-analysis was performed.
P23. "Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression [see Item 16])."
[NA] No additional analyses were performed.
P24. "Summarize the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers)."
"The benefits and harms of interventions for primary VUR were assessed in 20 studies involving 2324 children."
[Yes] The main findings are summarized.
P25. "Discuss limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias)."
"The quality of conduct and reporting of these studies was variable, with many studies omitting crucial methodological information used to assess the risk of bias."
[Yes] The limitations at the study and review level are discussed.
P26. "Provide a general interpretation of the results in the context of other evidence, and implications for future research."
"Compared with no treatment, use of long-term, low-dose antibiotics did not significantly reduce the number of repeat symptomatic and febrile UTIs in children with VUR. Correcting VUR using endoscopic approaches or open surgery did not significantly reduce the number of symptomatic or febrile UTIs compared with antibiotic prophylaxis alone. We still need a well-designed, blinded and adequately powered study in children with VUR to resolve the remaining uncertainty surrounding the benefit of antibiotic prophylaxis in preventing UTI and renal damage."
[Yes] The results are interpreted in context and implications for future research are provided.
P27. "Describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review."
"Australian Kidney Foundation, Seeding Grant number S2/99, Australia."
[Yes] The source of funding for the systematic review is reported.
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
0
|
0
|
1
|
1
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
0
|
NA
|
1
|
1
|
0
|
1
|
1
|
0
|
NA
|
1
|
0
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
NA
|
1
|
1
|
0
|
1
|
1
|
NA
|
NA
|
1
|
1
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
1
|
1
|
0
|
0
|
1
|
0
|
0
|
1
|
0
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
1
|
1
|
0
|
0
|
1
|
0
|
0
|
1
|
0
|
0
|
LLM response
21 quote(s) from
publication full text (mean similarity 98.8%)
A1. Was an 'a priori' design provided?
Quotes: None relevant
Reasoning: The article does not mention a protocol, ethics approval, or pre-registered objectives.
[No]
A2. Was there duplicate study selection and data extraction?
Quotes: "Three reviewers (SKN, KLN and CY) independently assessed selected studies, extracted and tabulated data from each article"
Reasoning: Study selection and data extraction were done independently by multiple reviewers.
[Yes]
A3. Was a comprehensive literature search performed?
Quotes: "A Medline, Ovid, Search Medica, Elsevier ClinicalKey, Google Scholar and the Cochrane library were chosen and data extracted for meta-analysis."
Reasoning: At least 2 electronic databases plus supplementary sources were searched.
[Yes]
A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion?
Quotes: None relevant
Reasoning: The article does not mention searching for grey literature or including studies regardless of publication type.
[No]
A5. Was a list of studies (included and excluded) provided?
Quotes: "Five studies were excluded as they included comparisons of interposition hepaticoduodenostomy or one of its modifications [2,9–11,12]. One study was excluded as the comparison was unclear [13], leaving 6 studies for meta-analysis [14–18,19]."
Reasoning: Excluded studies are referenced but not included studies.
[No]
A6. Were the characteristics of the included studies provided?
Quotes: "The characteristics of these studies are demonstrated in Table 1."
Reasoning: Key characteristics of included studies are provided in an aggregated table.
[Yes]
A7. Was the scientific quality of the included studies assessed and documented?
Quotes: None relevant
Reasoning: The article does not mention assessing risk of bias or methodological quality of the included studies.
[No]
A8. Was the scientific quality of the included studies used appropriately in formulating conclusions?
Quotes: None relevant
Reasoning: Scientific quality was not assessed (see A7) so could not be used to inform conclusions.
[No]
A9. Were the methods used to combine the findings of studies appropriate?
Quotes: "Heterogeneity was assessed using I2. A fixed effects model was used if I2 <50% and a random effects model was used if I2 ≥50%. Statistical analysis was performed using Review Manager 5.2 (Cochrane Collaboration)."
Reasoning: Appropriate methods were used to assess heterogeneity and combine studies.
[Yes]
A10. Was the likelihood of publication bias assessed?
Quotes: None relevant
Reasoning: Publication bias was not assessed.
[No]
A11. Was the conflict of interest included?
Quotes: None relevant
Reasoning: Sources of support for the systematic review and included studies are not reported.
[No]
P1. Title
Quotes: "Hepaticoduodenostomy versus hepaticojejunostomy after resection of choledochal cyst: A systematic review and meta-analysis"
Reasoning: The title identifies the article as a systematic review and meta-analysis.
[Yes]
P2. Abstract / Structured summary
Quotes: See structured abstract with Background, Materials and Methods, Results, and Conclusions sections
Reasoning: The article provides a structured abstract with the required sections.
[Yes]
P3. Introduction / Rationale
Quotes: "Choledochal cysts are congenital bile duct anomalies with cystic dilatation of the biliary tree and have potential for various complications. Most of the reported cases in the world come from Asia but the management in the western world. Complete resection of the extra hepatic bile duct is the accepted management of choledochal cyst [1]. The management of the choledochal cysts has evolved from simple drainage procedures to the most innovative bilio-enteric anastomotic reconstruction."
Reasoning: The introduction describes the rationale for the review in the context of what is known about choledochal cysts and their management.
[Yes]
P4. Introduction / Objectives
Quotes: "To compare the clinical outcomes of HD and HJ, we performed a systematic review and comprehensive meta-analysis from indexed published literature."
Reasoning: The objectives are stated, although without explicit reference to PICOS.
[Yes]
P5. Methods / Protocol and registration
Quotes: None relevant
Reasoning: The article does not mention a protocol or registration number.
[No]
P6. Methods / Eligibility criteria
Quotes: "To enter the analysis, studies had to (1) report the reconstructive techniques after excision of choledochal cyst; (2) have comparative data for HD and HJ operations available; (3) report on at least one of the outcome measures mentioned below; and (4) have been published as a full paper in a journal, not as meeting abstract or review."
Reasoning: Eligibility criteria are specified with rationale.
[Yes]
P7. Methods / Information sources
Quotes: "A Medline, Ovid, Search Medica, Elsevier ClinicalKey, Google Scholar and the Cochrane library. Suitable studies were chosen and data extracted for meta-analysis. The latest search was performed in December 2012."
Reasoning: Databases searched and date of last search are reported.
[Yes]
P8. Methods / Search
Quotes: "The following keywords were used: "choledochal cyst", "choledochal cyst AND hepaticoduodenostomy", "choledochal cyst AND hepaticojejunostomy", "hepaticoduodenostomy", "hepaticojejunostomy", "hepaticoduoduodenostomy". The "related articles" function was used to widen the search."
Reasoning: The full search strategy is not presented but the keywords used are provided.
[No]
P9. Methods / Study selection
Quotes: "Five studies were excluded as they included comparisons of interposition hepaticoduodenostomy or one of its modifications [2,9–11,12]. One study was excluded as the comparison was unclear [13], leaving 6 studies for meta-analysis [14–18,19]."
Reasoning: The process for selecting studies is described.
[Yes]
P10. Methods / Data collection process
Quotes: "Three reviewers (SKN, KLN and CY) independently assessed selected studies, extracted and tabulated data from each article"
Reasoning: Data extraction was done independently by multiple reviewers.
[Yes]
P11. Methods / Data items
Quotes: None relevant
Reasoning: Data items are not explicitly defined, although some outcomes are mentioned.
[No]
P12. Methods / Risk of bias in individual studies
Quotes: None relevant
Reasoning: Assessment of risk of bias in individual studies is not described.
[No]
P13. Methods / Summary measures
Quotes: "Odds ratios (OR) were calculated for dichotomous variables; pooled mean differences (MD) were measured for continuous variables."
Reasoning: The main summary measures are stated.
[Yes]
P14. Methods / Synthesis of results
Quotes: "Heterogeneity was assessed using I2. A fixed effects model was used if I2 <50% and a random effects model was used if I2 ≥50%. Statistical analysis was performed using Review Manager 5.2 (Cochrane Collaboration)."
Reasoning: Methods for assessing heterogeneity and combining results are described.
[Yes]
P15. Methods / Risk of bias across studies
Quotes: None relevant
Reasoning: Methods for assessing risk of bias across studies (e.g. publication bias) are not mentioned.
[No]
P16. Methods / Additional analyses
Quotes: None relevant
Reasoning: No additional analyses are mentioned.
[NA]
P17. Results / Study selection
Quotes: "The initial search yielded 14 articles meeting the inclusion criteria. Out of 14 studies, two studies were excluded because they overlapped with their own later studies [7,8]. Five studies were excluded as they included comparisons of interposition hepaticoduodenostomy or one of its modifications [2,9–11,12]. One study was excluded as the comparison was unclear [13], leaving 6 studies for meta-analysis [14–18,19]."
Reasoning: The number of studies screened, assessed, included and excluded are reported with reasons.
[Yes]
P18. Results / Study characteristics
Quotes: "The characteristics of these studies are demonstrated in Table 1."
Reasoning: Study characteristics are provided for each included study.
[Yes]
P19. Results / Risk of bias within studies
Quotes: None relevant
Reasoning: Results of risk of bias assessment for individual studies are not reported.
[No]
P20. Results / Results of individual studies
Quotes: See Table 2 and forest plots
Reasoning: Results for each study and outcome are provided in tables and figures.
[Yes]
P21. Results / Synthesis of results
Quotes: See forest plots and text
Reasoning: Results of meta-analyses with confidence intervals and measures of consistency are reported.
[Yes]
P22. Results / Risk of bias across studies
Quotes: None relevant
Reasoning: Results of assessment of risk of bias across studies (e.g. publication bias) are not reported.
[NA]
P23. Results / Additional analysis
Quotes: None relevant
Reasoning: No additional analyses were mentioned in the methods, so results are not expected.
[NA]
P24. Discussion / Summary of evidence
Quotes: "The choice between HD and HJ is still a matter of debate. Our meta-analysis suggests that the HD is comparable to conventional HJ in most postoperative outcomes except a higher rate of gastric reflux. To our knowledge this study is the first systematic review and meta-analysis comparing HD to HJ."
Reasoning: The main findings are summarized with relevance to key stakeholders.
[Yes]
P25. Discussion / Limitations
Quotes: "There are few limitations in this study. The lack of randomized trial comparing the two procedures is a key problem. All six included studies are retrospective observational studies which are prone to selection bias and may result in uneven distribution of confounding factors such as age of patient, duration of follow-up and type of choledochal cyst."
Reasoning: Limitations at the study, outcome and review level are discussed.
[Yes]
P26. Discussion / Conclusions
Quotes: "Based on the evidence of this study, HD as a method of reconstruction after excision of a choledochal cyst is a suitable alternative to HJ. Though reflux/gastritis is higher in the HD group, it could possibly be avoided with a construction of the HD anastomosis at the junction of the first and second portions of the duodenum after an extensive Kocher maneuver to prevent any tension on the anastomosis. This should be well distal to the pylorus and should not impact pyloric function or gastric emptying significantly [17]."
Reasoning: The conclusions provide a general interpretation of results in the context of other evidence and implications for future research.
[Yes]
P27. Funding
Quotes: None relevant
Reasoning: Sources of funding and support are not described.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
0
|
1
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
1
|
NA
|
0
|
1
|
0
|
1
|
1
|
0
|
NA
|
1
|
0
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
0
|
0
|
1
|
0
|
0
|
0
|
0
|
0
|
1
|
1
|
0
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
1
|
1
|
0
|
0
|
1
|
1
|
1
|
1
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
0
|
0
|
1
|
1
|
1
|
1
|
0
|
0
|
LLM response
19 quote(s) from
publication full text (mean similarity 99.5%)
1
quote(s) from the LLM prompt briefing (mean similarity 100%) -
were instructions quoted (ok) or examples (unwanted beahviour)?
A1
Quote: "To be selected, a study had to be designed to evaluate the Nuss vs the Ravitch procedure for the treatment of pectus excavatum and provide relevant and interpretable data. The comparison could be to another group, whether it was part of a controlled trial, a case control study, or a cohort study."
Reasoning: The authors specified the research question and inclusion criteria for the review.
[Yes]
A2
Quotes: "Two authors (AN and PW) independently extracted data from the retrieved articles. We contacted the primary authors of any articles for which there was inadequate information or if relevant data could not be extracted. Any discrepancies were resolved by consensus."
Reasoning: Two authors independently extracted data and resolved discrepancies by consensus.
[Yes]
A3
Quotes: "All publications describing both interventions were sought through the Cochrane Central Register of Controlled Trials (CENTRAL) database, MEDLINE, and EMBASE. The statistical analysis was performed using RevMan 5 software." "All studies were identified through electronic searches of MEDLINE (1966 onward), EMBASE (1980 onward), and CINAHL (1982 onward) and from hand-searching journals and conference proceedings."
Reasoning: At least 2 electronic databases were searched, supplemented by hand-searching journals and conference proceedings.
[Yes]
A4
Reasoning: The authors did not mention searching for grey literature or unpublished studies.
[No]
A5
Reasoning: A list of included studies was provided in Table 1, but a list of excluded studies was not provided.
[No]
A6
Quote: "For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations."
Reasoning: The characteristics of the included studies were provided in an aggregated form in Table 1.
[Yes]
A7
Quotes: "Quality criteria used for study inclusion included (i) appropriate selection of comparison/control group; (ii) control of factors such as selection bias, observation bias, and confounding; (iii) completeness of follow-up; and (iv) accurate outcome measurement." "There was no significant difference in overall complication rates between both techniques (OR, 1.75 (0.62-4.95); P = .30). Looking at specific complications, the rate of reoperation because of bar migration or persistent deformity was significantly higher in the Nuss group (OR, 5.68 (2.51-12.85); P = .0001)."
Reasoning: The authors assessed the methodological quality of included studies using specified criteria and considered it in the analysis.
[Yes]
A8
Quote: "There was no significant difference in overall complication rates between both techniques (OR, 1.75 (0.62-4.95); P = .30). Looking at specific complications, the rate of reoperation because of bar migration or persistent deformity was significantly higher in the Nuss group (OR, 5.68 (2.51-12.85); P = .0001)."
Reasoning: The scientific quality of the studies was appropriately considered in formulating conclusions.
[Yes]
A9
Quotes: "The statistical analysis was performed using RevMan 5 software, which was provided by the Cochrane Collaboration. We applied tests for between-study heterogeneity χ2 (Q test) and the I2 statistic to assess the appropriateness of combining studies. If the results of these tests showed heterogeneity (cutoff of 0.10 or larger for the Q test or >50%, heterogeneity with the I2 statistic), a random effect model was used for meta-analysis."
Reasoning: Appropriate methods were used to combine the findings of studies, assessing and accounting for heterogeneity.
[Yes]
A10
Reasoning: The authors did not mention assessing the likelihood of publication bias.
[No]
A11
Reasoning: The authors did not report on sources of support or conflict of interest for the included studies.
[No]
P1
Quote: "Comparison of the Nuss and the Ravitch procedure for pectus excavatum repair: a meta-analysis"
Reasoning: The title identifies the report as a meta-analysis.
[Yes]
P2
Quote: "Purpose: Pectus excavatum is the most common chest wall deformity in children. Two procedures are widely applied—the Nuss and the Ravitch. Several comparative studies are published evaluating both procedures with inconsistent results. Our objective was to compare the Nuss procedure to the Ravitch procedure using systematic review and meta-analysis methodology."
Reasoning: The abstract provides a structured summary including background, objectives, methods, and results.
[Yes]
P3
Quote: "Pectus excavatum is the most common congenital chest wall abnormality occurring in 8 per 1000 live births. The defect is noticeable at birth in 86% of infants, whereas a later onset is observed in patients with Marfan syndrome. The indications for repair of pectus excavatum are essentially cosmetic [1-4]."
Reasoning: The introduction describes the rationale for the review in the context of what is already known about pectus excavatum.
[Yes]
P4
Quote: "To be selected, a study had to be designed to evaluate the Nuss vs the Ravitch procedure for the treatment of pectus excavatum and provide relevant and interpretable data. The comparison could be to another group, whether it was part of a controlled trial, a case control study, or a cohort study."
Reasoning: The introduction provides an explicit statement of the question being addressed with reference to participants, interventions, comparisons, and study design.
[Yes]
P5
Reasoning: The authors did not mention if a review protocol exists or where it can be accessed.
[No]
P6
Quote: "To be selected, a study had to be designed to evaluate the Nuss vs the Ravitch procedure for the treatment of pectus excavatum and provide relevant and interpretable data. The comparison could be to another group, whether it was part of a controlled trial, a case control study, or a cohort study."
Reasoning: The methods section specifies the study characteristics and report characteristics used as criteria for eligibility.
[Yes]
P7
Quote: "All publications describing both interventions were sought from the Cochrane Trials Register of the Cochrane Central Register of Controlled Trials (CENTRAL) database. All studies were identified through electronic searches of MEDLINE (1966 onward), EMBASE (1980 onward), and CINAHL (1982 onward) and from hand-searching journals and conference proceedings."
Reasoning: The methods section describes the information sources searched and the date last searched.
[Yes]
P8
Reasoning: The authors did not present the full electronic search strategy for any of the databases.
[No]
P9
Quote: "Two authors (AN and PW) independently extracted data from the retrieved articles. We contacted the primary authors of any articles for which there was inadequate information or if relevant data could not be extracted. Any discrepancies were resolved by consensus."
Reasoning: The methods section states the process for selecting studies.
[Yes]
P10
Quote: "Two authors (AN and PW) independently extracted data from the retrieved articles. We contacted the primary authors of any articles for which there was inadequate information or if relevant data could not be extracted. Any discrepancies were resolved by consensus."
Reasoning: The methods section describes the data extraction process.
[Yes]
P11
Quote: "The primary outcome of this analysis was complication rates. Secondary outcomes included duration of hospitalization (days), duration of surgery (minutes), time to ambulation (days), postoperative pain management, and patient satisfaction. We included all studies that reported on one or more of these outcomes."
Reasoning: The methods section lists the variables for which data were sought.
[Yes]
P12
Quote: "Quality criteria used for study inclusion included (i) appropriate selection of comparison/control group; (ii) control of factors such as selection bias, observation bias, and confounding; (iii) completeness of follow-up; and (iv) accurate outcome measurement."
Reasoning: The methods section describes the criteria used to assess risk of bias in the individual studies.
[Yes]
P13
Reasoning: The authors did not explicitly state the principal summary measures.
[No]
P14
Quote: "The statistical analysis was performed using RevMan 5 software, which was provided by the Cochrane Collaboration. We applied tests for between-study heterogeneity χ2 (Q test) and the I2 statistic to assess the appropriateness of combining studies. If the results of these tests showed heterogeneity (cutoff of 0.10 or larger for the Q test or >50%, heterogeneity with the I2 statistic), a random effect model was used for meta-analysis."
Reasoning: The methods section describes the methods of handling data and combining results, including measures of consistency.
[Yes]
P15
Reasoning: The authors did not specify any assessment of risk of bias across studies that may affect the cumulative evidence.
[No]
P16
Reasoning: The authors did not describe any additional analyses.
[No]
P17
Reasoning: The results section does not provide the numbers of studies screened, assessed for eligibility, and included in the review at each stage, ideally with a flow diagram.
[No]
P18
Quote: "All data extracted from the 9 studies are summarized in Table 1."
Reasoning: Table 1 presents the characteristics of each included study.
[Yes]
P19
Reasoning: The results section does not present data on the risk of bias of each study.
[No]
P20
Reasoning: The results section does not present simple summary data and effect estimates with confidence intervals for each study and outcome.
[No]
P21
Reasoning: The results of the meta-analyses are not presented with confidence intervals and measures of consistency.
[No]
P22
Reasoning: The authors did not assess the risk of bias across studies.
[No]
P23
Reasoning: No additional analyses were reported.
[No]
P24
Quote: "Our results suggest no differences between the Nuss procedure vs the Ravitch procedure with respect to overall complications, length of hospital stay, and time to ambulation. However, the rate of reoperation, postoperative hemothorax, and pneumothorax after the Nuss procedure were higher compared to the Ravitch procedure."
Reasoning: The discussion summarizes the main findings including the strength of evidence for the main outcomes.
[Yes]
P25
Quote: "Meta-analysis was originally designed to compare outcomes of randomized trials. It is possible to perform meta-analysis for observational studies, but the risk of contamination from bias and confounding is increased. Retrospective cohort studies are particularly susceptible to bias, especially patient selection."
Reasoning: The discussion addresses limitations at the study and review level.
[Yes]
P26
Reasoning: The authors did not provide a general interpretation of the results in the context of other evidence or discuss implications for future research.
[No]
P27
Reasoning: The authors did not describe sources of funding for the systematic review.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
0
|
0
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
1
|
0
|
0
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
0
|
0
|
0
|
0
|
1
|
0
|
0
|
0
|
0
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
0
|
NA
|
0
|
0
|
0
|
0
|
0
|
0
|
NA
|
1
|
1
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
NA
|
NA
|
0
|
1
|
0
|
0
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
1
|
0
|
0
|
1
|
1
|
1
|
1
|
0
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
0
|
1
|
0
|
0
|
0
|
1
|
1
|
NA
|
NA
|
0
|
LLM response
12 quote(s) from
publication full text (mean similarity 99.8%)
A1
"To critically appraise the methodological quality of studies describing the Foker procedure."
The objectives section states the research questions and inclusion criteria.
[Yes]
A2
No mention of duplicate study selection or data extraction.
[No]
A3
"All publications describing both surgical procedures were sought from the Cochrane Trials Register and the Cochrane Central Register of Controlled Trials database. All studies were identified through electronic searches of MEDLINE (1966 onward), PubMed (1980 onward), and CINAHL (1982 onward), and from hand searching journals and conference proceedings."
Multiple databases and supplementary sources were searched.
[Yes]
A4
No mention of including grey literature or unpublished studies.
[No]
A5
No list of included and excluded studies provided.
[No]
A6
"The literature search resulted in a total of 115 articles, after screening and exclusion of nonrelevant and duplicate publications. Six articles met our criteria for inclusion and the full text was examined more in detail."
Some study characteristics are provided in aggregate, but more details could have been reported.
[No]
A7
"Our methodological assessment revealed that the studies ranged from poor to moderate quality."
The methodological quality of included studies was assessed.
[Yes]
A8
"Although time to complete oral intake was not reported in most studies, it is logical to assume that earlier restoration of esophageal continuity would translate into faster oral intake by the infants. Our analysis also showed that reported complication rates may be higher in the delayed anastomosis group."
The results consider the limitations in study quality.
[Yes]
A9
No meta-analysis was performed.
[NA]
A10
No assessment of publication bias.
[NA]
A11
No disclosure of funding sources or conflicts of interest.
[No]
P1
The title identifies the article as a critical appraisal.
[Yes]
P2
The abstract is structured with labeled sections for background, objectives, methods, results, and conclusions.
[Yes]
P3
"Long-gap esophageal atresia (EA) represents a challenging problem for pediatric surgeons, and a large number of techniques and approaches have been proposed. One of the more recent, initially published by Foker, is the use of mechanical traction to accelerate the growth of the esophageal ends and permit earlier primary anastomosis."
The introduction provides rationale and context for the review.
[Yes]
P4
"To critically appraise the methodological quality of studies describing the Foker procedure. To compare the outcomes of the Foker procedure to the more commonly used delayed primary anastomosis approach."
The objectives are stated in terms of PICO.
[Yes]
P5
No mention of a review protocol or registration.
[No]
P6
No detailed eligibility criteria provided in terms of PICOS.
[No]
P7
"All publications describing both surgical procedures were sought from the Cochrane Trials Register and the Cochrane Central Register of Controlled Trials database. All studies were identified through electronic searches of MEDLINE (1966 onward), PubMed (1980 onward), and CINAHL (1982 onward), and from hand searching journals and conference proceedings."
Information sources are described but the date last searched is not provided.
[No]
P8
No search strategy provided.
[No]
P9
"The literature search resulted in a total of 115 articles, after screening and exclusion of nonrelevant and duplicate publications. Six articles met our criteria for inclusion and the full text was examined more in detail."
The study selection process is briefly described.
[Yes]
P10
No description of the data collection process.
[No]
P11
No list of data items extracted.
[No]
P12
"Our methodological assessment revealed that the studies ranged from poor to moderate quality."
Risk of bias was assessed but the specific tool or methods are not described.
[No]
P13
No summary measures are specified.
[No]
P14
No meta-analysis was performed.
[NA]
P15
No assessment of risk of bias across studies.
[NA]
P16
No additional analyses performed.
[NA]
P17
No PRISMA flow diagram provided.
[No]
P18
Characteristics of included studies are provided in Tables 1-3.
[Yes]
P19
No study-level risk of bias assessments presented.
[No]
P20
No individual study results presented.
[No]
P21
No meta-analysis performed.
[NA]
P22
No assessment of risk of bias across studies.
[NA]
P23
No additional analyses performed.
[NA]
P24
The Discussion summarizes the main findings and their relevance.
[Yes]
P25
"It is important to point out that the results of this meta-analysis should be interpreted with caution. All studies published in the literature on this topic are retrospective and noncomparative. Retrospective cohort studies are particularly susceptible to bias, especially with respect to patient selection."
Limitations are discussed at the study and review level.
[Yes]
P26
"Future prospective studies and the establishment of a prospective registry are required to further elucidate this issue."
Implications for future research are provided.
[Yes]
P27
No funding sources disclosed.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
0
|
0
|
1
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
1
|
NA
|
1
|
1
|
0
|
1
|
1
|
1
|
NA
|
1
|
0
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
NA
|
NA
|
1
|
0
|
0
|
0
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
1
|
0
|
0
|
0
|
1
|
0
|
0
|
1
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
0
|
1
|
0
|
0
|
0
|
0
|
NA
|
1
|
1
|
0
|
LLM response
24 quote(s) from
publication full text (mean similarity 99.7%)
A1. Was an 'a priori' design provided?
Quote: "We performed a systematic review and meta-analysis of all relevant studies published between 1990 and 2012. The main outcome measure was the incidence of postoperative IAA"
The authors stated the research question and outcome measure a priori.
[Yes]
A2. Was there duplicate study selection and data extraction?
Quote: "Once identification of possible relevant articles had occurred, a single reviewer screened abstracts. Those that related to pediatric LA and/or OA with data reporting on the incidence of postoperative IAA, as well as the incidence of WI and/or SBO, were included. Once the initial screening had been screened and the relevant articles had been identified, full text articles in the English language were retrieved and screened in detail."
A single reviewer screened abstracts and full texts, no mention of duplicate study selection or data extraction.
[No]
A3. Was a comprehensive literature search performed?
Quotes: "A review of the literature was performed to identify all published evidence relating to the development of a pediatric IAA postoperatively after either LA or OA. To ensure that all relevant articles were identified and included in the final analysis, broad search terms were used (including variations of the multiple key words), and multiple databases were screened (Table 1). The search was limited to journal articles from January 1990 to January 2012."
"The search strategy and results are summarized in Figure 1."
Multiple databases and broad search terms were used. The search strategy is provided in Table 1 and Figure 1.
[Yes]
A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion?
The authors did not state that they searched for reports regardless of publication type or whether they excluded any reports based on publication status.
[No]
A5. Was a list of studies (included and excluded) provided?
The number of included studies is provided in Figure 1, but no list of the actual included or excluded studies is given.
[No]
A6. Were the characteristics of the included studies provided?
Quote: "The 66 studies included in the present analysis contained data on 22,060 pediatric patients who underwent LA or OA"
Table 3 provides aggregated characteristics of the included studies, but no details on individual study characteristics.
[No]
A7. Was the scientific quality of the included studies assessed and documented?
The authors did not provide any information on assessing the scientific quality or risk of bias of the included studies.
[No]
A8. Was the scientific quality of the included studies used appropriately in formulating conclusions?
As study quality was not assessed, it could not be considered in the analysis or conclusions.
[NA]
A9. Were the methods used to combine the findings of studies appropriate?
Quotes: "Analysis was performed using GraphPad Prism (GraphPad Software Inc., La Jolla, CA). P values of <.05 were considered statistically significant."
"Funnel plots of data from studies reporting direct comparisons between LA and OA in pediatric patients were used to assess for publication bias."
Appropriate statistical methods were used to combine the findings. Heterogeneity was not assessed as it is not relevant for the proportional meta-analysis performed.
[Yes]
A10. Was the likelihood of publication bias assessed?
Quote: "Funnel plots of data from studies reporting direct comparisons between LA and OA in pediatric patients were used to assess for publication bias. There was no obvious bias noted for any of the outcome measures of the present meta-analysis (Fig. 5)."
Publication bias was assessed using funnel plots for studies with direct comparisons of LA and OA.
[Yes]
A11. Was the conflict of interest included?
The source of funding for the systematic review is stated in the Disclosure Statement section. However, sources of support for the included individual studies are not reported.
[No]
P1. Title
Quote: "The Incidence of Intraabdominal Abscess Formation Following Laparoscopic Appendicectomy in Children: A Systematic Review and Meta-analysis"
The title identifies the report as a systematic review and meta-analysis.
[Yes]
P2. Abstract / Structured summary
The abstract is structured with labeled sections for Aims, Methods, Results, and Conclusions, covering the key elements of a systematic review abstract.
[Yes]
P3. Introduction / Rationale
Quote: "A CUTE APPENDICITIS IS A VERY COMMON pathology encountered in both pediatric and adult patient populations, with a lifetime risk of 7%–8%.1 There has been much recent research and debate over the best operative modality for an appendicectomy in a pediatric patient, despite the laparoscopic approach gaining popularity among pediatric surgeons.2 A recent Cochrane systematic review, which included both adult and pediatric studies, concluded that there was an increased incidence of intraabdominal abscess (IAA) following laparoscopic appendicectomy (LA) compared with the open approach (OA); the odds ratio (OR) was 2.48 (95% confidence interval [CI] 1.45–4.21).3 There have only been a few reviews on this topic in a pediatric population and fewer that have specifically focused on the incidence of postoperative complications such as IAA, wound infection (WI), and also small bowel obstruction (SBO).4–6"
The rationale for the review is described in the context of existing evidence on the topic.
[Yes]
P4. Introduction / Objectives
Quote: "We performed a systematic review and meta-analysis of all relevant studies published between 1990 and 2012. The main outcome measure was the incidence of postoperative IAA"
An explicit statement of the review question is provided, specifying the population, intervention, comparator and outcome.
[Yes]
P5. Methods / Protocol and registration
The authors did not indicate if a review protocol exists or provide registration information.
[No]
P6. Methods / Eligibility criteria
Quote: "All studies that included a cohort of pediatric patients having undergone LA or OA with IAA incidence reporting were included. The full inclusion and exclusion criteria are summarized in Table 2."
Table 2 specifies the study characteristics used as criteria for eligibility.
[Yes]
P7. Methods / Information sources
Quote: "A review of the literature was performed to identify all published evidence relating to the development of a pediatric IAA postoperatively after either LA or OA. To ensure that all relevant articles were identified and included in the final analysis, broad search terms were used (including variations of the multiple key words), and multiple databases were screened (Table 1). The search was limited to journal articles from January 1990 to January 2012."
The databases searched and date ranges are described.
[Yes]
P8. Methods / Search
Quote: "The search strategy and results are summarized in Figure 1."
Table 1 also provides the search terms/keywords used for the database searches.
[Yes]
P9. Methods / Study selection
Quote: "Once identification of possible relevant articles had occurred, a single reviewer screened abstracts. Those that related to pediatric LA and/or OA with data reporting on the incidence of postoperative IAA, as well as the incidence of WI and/or SBO, were included. Once the initial screening had been screened and the relevant articles had been identified, full text articles in the English language were retrieved and screened in detail."
The process for selecting studies is stated.
[Yes]
P10. Methods / Data collection process
Quote: "Data were extracted from the individual studies and collated on a database. The main analysis included data from all studies selected for our systematic review."
The data extraction method is described.
[Yes]
P11. Methods / Data items
The authors did not provide a list of all variables for which data were sought.
[No]
P12. Methods / Risk of bias in individual studies
The authors did not describe any methods used for assessing risk of bias in individual studies.
[No]
P13. Methods / Summary measures
Quote: "Analysis was performed using GraphPad Prism (GraphPad Software Inc., La Jolla, CA). P values of <.05 were considered statistically significant."
The principal summary measures (odds ratios and P values) are stated.
[Yes]
P14. Methods / Synthesis of results
Meta-analysis methods are not described, as quantitative synthesis was not performed.
[NA]
P15. Methods / Risk of bias across studies
Assessment of risk of bias across studies, such as publication bias or selective reporting, is not described.
[NA]
P16. Methods / Additional analyses
Subgroup and sensitivity analyses are not described.
[NA]
P17. Results / Study selection
Quote: "In total, 2874 titles and abstracts were identified from the combined searches from the databases listed in Table 1 for the period from January 1, 1990 to January 5, 2012. From these, 284 full-text journal articles were retrieved and reviewed in detail. Sixty-six of the latter studies contained data that was relevant to the formation of an IAA following a pediatric LA or OA and were therefore included in our analysis."
Figure 1 provides a flowchart of the study selection process with reasons for exclusions at each stage.
[Yes]
P18. Results / Study characteristics
Quote: "The 66 studies included in the present analysis contained data on 22,060 pediatric patients who underwent LA or OA"
Aggregated study characteristics are provided, but characteristics of individual studies are not presented.
[No]
P19. Results / Risk of bias within studies
The authors did not present any data on the risk of bias of individual studies.
[No]
P20. Results / Results of individual studies
Forest plots are provided showing odds ratios and confidence intervals for individual studies comparing LA and OA for the outcomes of IAA, WI and SBO (Figures 2-4). However, simple summary data for each group are not presented.
[No]
P21. Results / Synthesis of results
Meta-analysis was not performed.
[NA]
P22. Results / Risk of bias across studies
Assessment of risk of bias across studies is not reported.
[NA]
P23. Results / Additional analysis
Additional analyses were not performed.
[NA]
P24. Discussion / Summary of evidence
Quotes: "Several interesting points are raised by this review. The first is that there is a scarcity of Level I evidence for the treatment of pediatric acute appendicitis by either operative modality, despite the condition being one of the most common emergencies that a pediatric surgeon will encounter."
"We have also found that when all the patients are analyzed, there is no difference between the IAA incidences following either LA or OA in a pediatric patient. This is in contrast to the findings of the Cochrane review.3"
The main findings are summarized, including their relevance to key groups.
[Yes]
P25. Discussion / Limitations
Quote: "There is also a protective effect of using the laparoscopic technique in terms of the occurrence of WI or SBO in the postoperative period. The subset analysis revealed that there is a greater incidence of IAA formation following LA in patients presenting with complicated appendicitis. This may potentially be explained by the increased time required for a thorough washout with the LA technique, or that there may be a negative effect on the pneumoperitoneum on the intraperitoneal distribution of purulent material.12,13"
Limitations at the study and review level are discussed.
[Yes]
P26. Discussion / Conclusions
Quote: "Overall, this systematic review of pediatric patients has shown that there is no difference between the LA and OA techniques in terms of IAA formation, which is different from the findings of the Cochrane review.3 The LA technique decreases the incidence of WI and also has a protective effect on the formation of postoperative SBO."
A general interpretation of the results in the context of other evidence is provided, along with implications for future research.
[Yes]
P27. Funding
Quote: "No competing financial interests exist."
Sources of funding for the systematic review are described in the Disclosure Statement. However, sources of support for the included individual studies are not reported.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
1
|
0
|
1
|
0
|
NA
|
NA
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
0
|
1
|
0
|
0
|
0
|
1
|
0
|
0
|
0
|
0
|
0
|
0
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
0
|
0
|
0
|
NA
|
NA
|
NA
|
NA
|
1
|
0
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
NA
|
0
|
1
|
0
|
0
|
NA
|
NA
|
NA
|
0
|
1
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
0
|
0
|
0
|
0
|
1
|
1
|
NA
|
NA
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
0
|
0
|
0
|
0
|
1
|
0
|
0
|
NA
|
0
|
0
|
LLM response
17 quote(s) from
publication full text (mean similarity 99.5%)
A1
Quote: "The aim of this study is to assess the role of laparoscopy in the diagnosis and therapy of BAT."
Reasoning: The research objective is clearly stated.
[Yes]
A2
Quotes: "All articles published during the mentionated period associated with these keywords were selected. All articles referring to pediatric surgery, penetrating trauma, nontraumatic abdominal emergencies, iatrogenic injury were excluded."
"The articles have been grouped based on their scientific content: original studies on patients with multiples and single organ injuries, reviews, and case reports."
Reasoning: Study selection and data extraction methods are described, but it is not explicitly stated that these were done in duplicate.
[No]
A3
Quote: "A comprehensive literature search was performed on the U.S. National Library of Medicine site in Medline and PubMed from 1 Jan 2000 to 31 Dec 2007 using keywords such as "laparoscopy and blunt abdominal trauma"."
Reasoning: Only one electronic database (PubMed/Medline) was searched.
[No]
A4
Reasoning: The inclusion of grey literature is not mentioned.
[No]
A5
Reasoning: A list of included and excluded studies is not provided.
[No]
A6
Quote: "97 articles from Medline/PubMed were reviewed. Thirty-seven articles were excluded. This paper reviews 66 articles that met the inclusion criteria. With the scientific content reviewed, the articles were divided in three categories shown in Table 1, 2 and 3 which also include the number of investigated patients."
Reasoning: Some characteristics of the included studies are provided in an aggregated form in Tables 1-3.
[Yes]
A7
Quotes: "The articles have been grouped based on their scientific content: original studies on patients with multiples and single organ injuries, reviews, and case reports."
"With the scientific content reviewed, the articles were divided in three categories shown in Table 1, 2 and 3 which also include the number of investigated patients."
Reasoning: The scientific quality of included studies was not assessed.
[No]
A8
Reasoning: Since the scientific quality of included studies was not assessed (A7), this item is scored as No.
[No]
A9
Reasoning: This systematic review does not include a meta-analysis, so assessing the appropriateness of methods for combining studies is not applicable.
[NA]
A10
Reasoning: The likelihood of publication bias is not assessed.
[No]
A11
Reasoning: Conflicts of interest or funding sources are not reported for the systematic review itself or the included studies.
[No]
P1
Quote: "Is laparoscopy still needed in blunt abdominal trauma?"
Reasoning: The title identifies the article as addressing laparoscopy in blunt abdominal trauma, but does not explicitly state it is a systematic review.
[No]
P2
Quote: "Laparoscopia diagnostică şi terapeutică în contuziile abdominale (CA) are o utilizare limitată şi cine controversată, datorită în special progreselor făcute de explorările imagistice actuale. Scopul lucrării noastre este de a evalua rolul actual al laparoscopiei în CA. Am efectuat un studiu al articolelor publicate asupra rolului laparoscopiei în CA în Pubmed şi Medline în perioada ianuarie 2000 - decembrie 2007. Articolele de chirurgie infantilă, cele referitoare la plăgile abdominale, urgenţele abdominale nontraumatice, leziunile iatrogene au fost excluse. Am evaluat 66 de articole care au inclus 22 de studii clinice, 27 de serii de cazuri, 17 review-uri şi 2 ghiduri. Studiile clinice au însumat 343 pacienţi cu CA abordaţi laparoscopic. Laparoscopia terapeutică a fost posibilă la 168 de pacienţi (48,98%). 51 de pacienţi au impus conversia(14,87%). Nu au fost leziuni omise, au fost doar 6 pacienţi cu complicaţii (1,75%) şi nu s-au înregistrat decese imputabile laparoscopiei. Indicaţiile principale ale laparoscopiei diagnostice în CA sunt reprezentate de suspiciunea de leziune diafragmatică respectiv suspiciunea de leziuni ale organelor cavitare la pacienţii cu examen clinic şi explorări imagistice echivoc. Este indicată şi în cazul pacienţilor cu suspiciune de leziuni traumatice viscerale la care nu se poate efectua în urgenţă explorări imagistice performante. În concluzie, deşi puţin utilizată, dovada fiind şi numărul redus de articole publicate, laparoscopia poate fi utilă la pacienţii cu CA dacă sunt selectaţi cu atenţie. Diagnostică echivoc în scopul reducerii incidenţei laparotomiilor inutile. Studii multicentrice prospective sunt necesare pentru a contura mai precis rolul laparoscopiei în CA."
Reasoning: The abstract provides a structured summary including background, objectives, data sources, study selection criteria, results, and conclusions. However, it lacks information on participants, interventions, study appraisal and synthesis methods, limitations, and systematic review registration number.
[No]
P3
Quote: "Unfortunately, trauma is still the leading cause of death in people under 50 years of age (1). However, remarkable progress has been made in trauma management over the past few years that includes various specific protocols, emergence of a new surgical specialty (trauma and emergency surgery), non-operative management, damage control techniques, improved imaging investigations and minimally invasive therapy (1-4)."
Reasoning: The introduction describes the rationale for the review in the context of current trauma management and the role of minimally invasive therapy like laparoscopy.
[Yes]
P4
Quote: "The aim of this study is to assess the role of laparoscopy in the diagnosis and therapy of BAT."
Reasoning: The introduction provides an explicit statement of the review question, but does not fully reference the PICOS elements.
[No]
P5
Reasoning: The existence of a review protocol and registration information are not reported.
[No]
P6
Quotes: "All articles published during the mentionated period associated with these keywords were selected. All articles referring to pediatric surgery, penetrating trauma, nontraumatic abdominal emergencies, iatrogenic injury were excluded."
"The articles have been grouped based on their scientific content: original studies on patients with multiples and single organ injuries, reviews, and case reports."
Reasoning: The eligibility criteria in terms of study characteristics (keywords, publication period) and report characteristics (publication types) are specified. However, the rationale for these criteria is not provided.
[No]
P7
Quote: "A comprehensive literature search was performed on the U.S. National Library of Medicine site in Medline and PubMed from 1 Jan 2000 to 31 Dec 2007 using keywords such as "laparoscopy and blunt abdominal trauma"."
Reasoning: The information sources searched (PubMed/Medline) and dates of coverage are described, but it is not mentioned if additional sources like contacting study authors were used.
[Yes]
P8
Reasoning: The full electronic search strategy is not presented such that it could be repeated.
[No]
P9
Quote: "All articles published during the mentionated period associated with these keywords were selected. All articles referring to pediatric surgery, penetrating trauma, nontraumatic abdominal emergencies, iatrogenic injury were excluded."
Reasoning: The process for selecting studies (inclusion/exclusion criteria) is described, but the number of studies screened, assessed for eligibility, and included at each stage is not provided, ideally with a flow diagram.
[No]
P10
Reasoning: The method of data extraction is not described.
[No]
P11
Reasoning: The data items and variables sought are not defined, although some can be inferred from the tables.
[No]
P12
Reasoning: The methods used for assessing risk of bias in individual studies are not described.
[No]
P13
Reasoning: The principal summary measures are not explicitly stated, as no quantitative synthesis was performed.
[No]
P14
Reasoning: This systematic review does not include a meta-analysis, so describing methods for combining results is not applicable.
[NA]
P15
Reasoning: Methods for assessing risk of bias that may affect the cumulative evidence are not specified.
[No]
P16
Reasoning: This systematic review does not include a meta-analysis, so describing methods of additional analyses is not applicable.
[NA]
P17
Quote: "97 articles from Medline/PubMed were reviewed. Thirty-seven articles were excluded."
Reasoning: The number of studies screened and included is provided, but a full study flow diagram giving reasons for exclusions at each stage is not presented.
[No]
P18
Quote: "With the scientific content reviewed, the articles were divided in three categories shown in Table 1, 2 and 3 which also include the number of investigated patients."
Reasoning: Study characteristics and citations are partially provided in Tables 1-3 for the included articles.
[Yes]
P19
Reasoning: Results on the risk of bias in each included study are not presented.
[No]
P20
Reasoning: For each study, simple summary data for each group and effect estimates with confidence intervals are not provided.
[No]
P21
Reasoning: This systematic review does not include a meta-analysis, so presenting meta-analytic results is not applicable.
[NA]
P22
Reasoning: This systematic review does not include a meta-analysis, so presenting results of risk of bias assessment across studies is not applicable.
[NA]
P23
Reasoning: This systematic review does not include a meta-analysis, so giving results of additional analyses is not applicable.
[NA]
P24
Reasoning: The discussion summarizes some of the main findings, but does not explicitly address the strength of evidence for each main outcome.
[No]
P25
Quote: "The main limitations attributed to laparoscopy were the lack of adequate equipment and trained medical personnel, the issue of general anesthesia, the fact that it is invasive, expensive, and does not allow a proper visualization of hollow organ injuries, particularly SBI, requires a longer operative time, and has specific complications (4-6,11, 66,71). Some of these limitations are now demoted."
Reasoning: Some limitations of laparoscopy at the review level are discussed.
[Yes]
P26
Quote: "In conclusion, although in the published studies it ranged between an acceptable 28 to 55 min (12-16). The postoperative complications did not exceed 1% in all meta-analysis from the 1990s (66,71). In all reviewed articles, the incidence of postoperative complications was between 0-6.3%, with no deaths associated to laparoscopy (14-18). With exploratory laparotomies, early postoperative complications reach an average incidence of 12-40%, late postoperative complications are 2-5%, and are associated with a death rate of 0-5% (16). The most common complications include pneumothorax, iatrogenic, visceral injuries, and extraperitoneal insufflation (4,8,13).There were no cases of gas embolization, not even in cases with large vessel injury."
Reasoning: The discussion provides a general interpretation of the results in the context of other evidence and implications for future research.
[Yes]
P27
Reasoning: Sources of funding for the systematic review are not described.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
0
|
0
|
0
|
0
|
0
|
1
|
0
|
NA
|
NA
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
0
|
0
|
1
|
0
|
0
|
0
|
0
|
0
|
NA
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
0
|
1
|
0
|
NA
|
NA
|
NA
|
NA
|
0
|
0
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
NA
|
NA
|
0
|
1
|
0
|
0
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
1
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
0
|
0
|
0
|
1
|
0
|
0
|
NA
|
NA
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
0
|
0
|
0
|
0
|
1
|
0
|
0
|
NA
|
0
|
0
|
LLM response
16 quote(s) from
publication full text (mean similarity 96.6%)
A1. Was an 'a priori' design provided?
Quotes: None relevant.
Reasoning: The article does not mention a protocol, ethics approval, or pre-determined objectives.
[No]
A2. Was there duplicate study selection and data extraction?
Quotes: None relevant.
Reasoning: The article does not state that at least two people independently selected studies and extracted data.
[No]
A3. Was a comprehensive literature search performed?
Quotes: "We performed a Pubmed search using the terms: neophalloplasty, neophallus, and phalloplasty. We discarded articles that reported gender reassignment female to male and series of neophalloplasty exclusively in the adult population."
Reasoning: Only one database (PubMed) was searched, without supplementary sources.
[No]
A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion?
Quotes: None relevant.
Reasoning: The article does not mention searching for or including grey literature.
[No]
A5. Was a list of studies (included and excluded) provided?
Quotes: "A total of 319 articles were identified in the initial search. Among the different techniques presented in the 19 papers collected initially, we were able to assemble reconstructive procedures into two groups: microsurgical and non-microsurgical techniques."
Reasoning: The number of included studies is provided, but no list of excluded studies is given.
[No]
A6. Were the characteristics of the included studies provided?
Quotes: "Table 1 Current literature for neophalloplasty."
Reasoning: Key characteristics of included studies are provided in an aggregated table.
[Yes]
A7. Was the scientific quality of the included studies assessed and documented?
Quotes: None relevant.
Reasoning: The article does not mention assessing study quality or risk of bias.
[No]
A8. Was the scientific quality of the included studies used appropriately in formulating conclusions?
Quotes: None relevant.
Reasoning: Study quality was not assessed (see A7), so could not be incorporated into the conclusions.
[No]
A9. Were the methods used to combine the findings of studies appropriate?
Quotes: None relevant.
Reasoning: This was a systematic review without a meta-analysis, so quantitative synthesis was not performed.
[NA]
A10. Was the likelihood of publication bias assessed?
Quotes: None relevant.
Reasoning: Publication bias was not assessed.
[No]
A11. Was the conflict of interest included?
Quotes: "Conflict of interest: None."
Reasoning: Conflicts of interest for the systematic review authors were reported, but not for the included studies.
[No]
P1. Title
Quotes: "Neophalloplasty in boys with aphallia: A systematic review"
Reasoning: The title identifies the article as a systematic review.
[Yes]
P2. Abstract / Structured summary
Quotes: The abstract is structured with labeled sections for Objective, Materials and methods, and Results.
Reasoning: The abstract is structured and contains most of the required elements.
[Yes]
P3. Introduction / Rationale
Quotes: "For many years, boys with aphallia have been referred for early female gender reassignment [3]. However, many children undergoing feminization refute the redesignated gender after puberty despite orchiectomy [4,5]. Moreover, an emerging paradigm suggests that gender reassignment should be performed preferably before puberty, taking into account psychological and psychiatric evaluation and counseling [6]."
Reasoning: The introduction describes the rationale for the review in the context of current knowledge.
[Yes]
P4. Introduction / Objectives
Quotes: "The aim of this systematic review was to assess all available literature on neophalloplasty in infancy with an interest in technical alternatives and clinical outcome."
Reasoning: The objective is explicitly stated, but without full PICOS elements.
[Yes]
P5. Methods / Protocol and registration
Quotes: None relevant.
Reasoning: No mention of a review protocol or registration.
[No]
P6. Methods / Eligibility criteria
Quotes: "We discarded articles that reported gender reassignment female to male and series of neophalloplasty exclusively in the adult population."
Reasoning: Some eligibility criteria are provided, but not with a full rationale.
[No]
P7. Methods / Information sources
Quotes: "We performed a Pubmed search using the terms: neophalloplasty, neophallus, and phalloplasty."
Reasoning: PubMed is mentioned as the only information source searched.
[Yes]
P8. Methods / Search
Quotes: "We performed a Pubmed search using the terms: neophalloplasty, neophallus, and phalloplasty."
Reasoning: The search terms are provided but not the full search strategy.
[No]
P9. Methods / Study selection
Quotes: "Among the different techniques presented in the 19 papers collected initially, we were able to assemble reconstructive procedures into two groups: microsurgical and non-microsurgical techniques."
Reasoning: The number of included studies is given, but the full process of screening and selection is not described.
[No]
P10. Methods / Data collection process
Quotes: None relevant.
Reasoning: The data collection process is not described.
[No]
P11. Methods / Data items
Quotes: None relevant.
Reasoning: Data items are not defined.
[No]
P12. Methods / Risk of bias in individual studies
Quotes: None relevant.
Reasoning: Assessment of risk of bias in individual studies is not mentioned.
[No]
P13. Methods / Summary measures
Quotes: None relevant.
Reasoning: Summary measures are not stated, as no quantitative synthesis was performed.
[NA]
P14. Methods / Synthesis of results
Quotes: None relevant.
Reasoning: No quantitative synthesis was performed.
[NA]
P15. Methods / Risk of bias across studies
Quotes: None relevant.
Reasoning: Assessment of risk of bias across studies is not mentioned and no quantitative synthesis was performed.
[NA]
P16. Methods / Additional analyses
Quotes: None relevant.
Reasoning: No additional analyses are mentioned and no quantitative synthesis was performed.
[NA]
P17. Results / Study selection
Quotes: "A total of 319 articles were identified in the initial search. Among the different techniques presented in the 19 papers collected initially, we were able to assemble reconstructive procedures into two groups: microsurgical and non-microsurgical techniques."
Reasoning: The number of included studies is provided, but no full study selection flow diagram is given.
[No]
P18. Results / Study characteristics
Quotes: "Table 1 Current literature for neophalloplasty."
Reasoning: Study characteristics and citations are provided in an aggregated table.
[Yes]
P19. Results / Risk of bias within studies
Quotes: None relevant.
Reasoning: Risk of bias assessments for individual studies are not reported.
[No]
P20. Results / Results of individual studies
Quotes: None relevant.
Reasoning: Results for individual studies are not provided, only in aggregate.
[No]
P21. Results / Synthesis of results
Quotes: None relevant.
Reasoning: No quantitative synthesis was performed.
[NA]
P22. Results / Risk of bias across studies
Quotes: None relevant.
Reasoning: Assessment of risk of bias across studies is not mentioned and no quantitative synthesis was performed.
[NA]
P23. Results / Additional analysis
Quotes: None relevant.
Reasoning: No additional analyses are mentioned and no quantitative synthesis was performed.
[NA]
P24. Discussion / Summary of evidence
Quotes: "In assessing recent literature, it seems rational that neophalloplasty should be regarded as the preferred strategy for boys born with aphallia, in opposition to female gender assignment."
Reasoning: The main findings are summarized with consideration of their relevance to key stakeholders.
[Yes]
P25. Discussion / Limitations
Quotes: "Recent literature documents a move away from female gender reassignment in aphallia, limited our group of patients to only 19 articles, and in some of them, adult patients were included with children in the same series (Table 1). A further analysis, searching articles describing neophalloplasty techniques in aphallia, limited our group consists of non-microsurgical techniques, including flap techniques. These have the advantage of simplicity and feasibility to be performed at younger age, but are necessarily planned according to a two-stage strategy, combined with prosthesis implantation in adolescence."
Reasoning: Limitations at the study and review level are discussed.
[Yes]
P26. Discussion / Conclusions
Quotes: "As a personal input, based on this review and considering our personal experience, we still believe that flap techniques should be the first choice when treating a child with penile agenesis."
Reasoning: A general interpretation of the results is provided along with implications for practice.
[Yes]
P27. Funding
Quotes: "Funding: None."
Reasoning: Funding sources for the systematic review are reported.
[Yes]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
1
|
1
|
1
|
0
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
0
|
1
|
0
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
0
|
NA
|
1
|
1
|
0
|
1
|
1
|
0
|
NA
|
1
|
0
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
NA
|
1
|
1
|
1
|
1
|
1
|
0
|
NA
|
1
|
1
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
1
|
1
|
0
|
0
|
1
|
1
|
1
|
1
|
0
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
0
|
0
|
LLM response
32 quote(s) from
publication full text (mean similarity 97.5%)
2
quote(s) from the LLM prompt briefing (mean similarity 42.4%) -
were instructions quoted (ok) or examples (unwanted beahviour)?
A1
Quote: "The aim of this study was to compare the results of both surgical strategies by means of a systematic review and meta-analysis of the available literature."
Reasoning: The research question and inclusion criteria were established a priori.
[Yes]
A2
Quotes: "Potentially eligible studies were reviewed independently by two authors (MWNO, RB) for inclusion and exclusion criteria. Studies were included in the review if they were RCTs that compared the results of LP and OP in children with HPS with admission time after pyloromyotomy and postoperative complication rate as outcomes."
"From the included studies, data on setting, methodological quality [according to the Cochrane handbook for systematic reviews of interventions (http://dcc.cochrane.org/sites/ dcc.cochrane.org/files/uploads/RCT)], population, and type of surgery were extracted by two authors independently, as well as data on primary and secondary outcome measures."
Reasoning: Study selection and data extraction were done independently by two authors.
[Yes]
A3
Quotes: "A systematic search for RCTs that compared open and LP was conducted. Retrieval of studies was done through a systematic search of the databases PubMed, Ovid (Ovid Technologies, New York, NY) and Cochrane (Cochrane database of systematic reviews). Both medical subject heading (MeSH) terms used were "pyloric stenosis," "pyloromyotomy," "comparative studies," "open," "laparoscopic," and "postoperative complications.""
"The full texts of the studies were read to determine whether the studies met the inclusion criteria. The reference lists of all articles that dealt with the topic of interest were scanned to check for additional publications. Disagreements about the inclusion of studies were resolved by group discussion (MWNO, RB, LTH). There were no language restrictions. No unpublished data were encountered."
Reasoning: A comprehensive search was performed using multiple databases and supplementary strategies like checking reference lists. No language restrictions were applied.
[Yes]
A4
Quote: "No unpublished data were encountered."
Reasoning: Unpublished data was searched for but not encountered.
[Yes]
A5
Quote: "Fifteen full papers were retrieved for more information of which 11 studies were excluded from the systematic review. These excluded articles were not randomized controlled trials [5, 11, 16–18], consisted only of a meta-analysis [19], used different end points [20] or different treatment strategies [21] and a RCT in which no laparoscopy was performed. Four RCTs with a total of 502 patients (OP 255, LP 247) fulfilled the inclusion criteria and were analyzed in this review [6–8, 13]."
Reasoning: A list of excluded studies with reasons for exclusion is provided.
[Yes]
A6
Quote: "Study details and the quality check of all RCTs are given in Tables 1, 2, respectively."
Reasoning: Tables 1 and 2 provide the characteristics of the included studies in an aggregated form.
[Yes]
A7
Quote: "From the included studies, data on setting, methodological quality [according to the Cochrane handbook for systematic reviews of interventions (http://dcc.cochrane.org/sites/ dcc.cochrane.org/files/uploads/RCT)], population, and type of surgery were extracted by two authors independently, as well as data on primary and secondary outcome measures."
Reasoning: The methodological quality of included studies was assessed using the Cochrane risk of bias tool.
[Yes]
A8
Quotes: "Despite this small benefit, LP can be acknowledged as the standard of care only if the included studies were of high quality and no heterogeneity between studies was found [12] and if the included studies were randomized and are therefore at higher risk of bias."
"It is important to note that every hospital has different standardized protocols for a feeding regimen, which makes an objective comparison difficult. A postoperative feeding schedule was started 6 h after recovery from anesthesia in the study of Hall et al. [7], while in the study of Leclair et al. [8], the feeding regimen was initiated 18 h after the operation."
Reasoning: The authors considered the methodological quality and risk of bias of the included studies when formulating conclusions and recommendations.
[Yes]
A9
Quotes: "Heterogeneity: Tau2 = 0.00; Chi2 = 6.73, df = 3 (P = 0.08); I2 = 55%"
"Heterogeneity: Chi2 = 3.63, df = 3 (P = 0.30); I2 = 17%"
"Heterogeneity: Chi2 = 2.35, df = 2 (P = 0.31); I2 = 15%"
"Heterogeneity: Chi2 = 1.86, df = 2 (P = 0.39); I2 = 0%"
Reasoning: Heterogeneity was assessed using the I2 statistic for each of the meta-analyses performed.
[Yes]
A10
Quote: "Furthermore, to our knowledge there is no randomized clinical trial or systematic review that described (major) complications as a primary outcome, which should be appreciated together with the possible positive outcomes."
Reasoning: Publication bias was not assessed. The authors acknowledge the lack of RCTs with complications as a primary outcome.
[No]
A11
Quotes: "Disclosures Dr. M. W. N. Oomen, Dr. L. T. Hoekstra, Dr. R. Bakx, Dr. D. T. Ubbink, and Prof. Dr. H. A. Heij have no conflicts of interest or financial ties to disclose."
"Open Access This article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited."
Reasoning: Conflicts of interest for the systematic review authors are disclosed. Funding sources of included studies are not reported.
[No]
P1
Quote: "Open Versus Laparoscopic Pyloromyotomy for Hypertrophic Pyloric Stenosis: A Systematic Review and Meta-Analysis Focusing on Major Complications"
Reasoning: The title identifies the article as a systematic review and meta-analysis.
[Yes]
P2
Quote: See the structured abstract on the first page of the article.
Reasoning: A structured abstract is provided with labeled sections for background, methods, results, and conclusion.
[Yes]
P3
Quote: "There is an ongoing debate about whether laparoscopic pyloromyotomy (LP) or open pyloromyotomy (OP) is the best option for treating hypertrophic pyloric stenosis (HPS). The aim of this study was to compare the results of both surgical strategies by means of a systematic review and meta-analysis of the available literature."
Reasoning: The rationale for the review is described in the context of the ongoing debate about LP vs OP for treating HPS.
[Yes]
P4
Quote: "The aim of this study was to compare the results of both surgical strategies by means of a systematic review and meta-analysis of the available literature."
Reasoning: The aim of the study implicitly specifies the PICO elements, although not explicitly labeled as such.
[Yes]
P5
Quote: No mention of a review protocol or registration.
Reasoning: The existence of a review protocol and registration information are not reported.
[No]
P6
Quote: "Studies were included in the review if they were RCTs that compared the results of LP and OP in children with HPS with admission time after pyloromyotomy and postoperative complication rate as outcomes. The primary outcome was major postoperative complications (i.e., incomplete pyloromyotomy, perforation, and need for reoperation). Secondary outcomes were time to full feed, postoperative hospital stay, and any other postoperative complications."
Reasoning: The eligibility criteria in terms of PICOS are specified.
[Yes]
P7
Quote: "A systematic search for RCTs that compared open and LP was conducted. Retrieval of studies was done through a systematic search of the databases PubMed, Ovid (Ovid Technologies, New York, NY) and Cochrane (Cochrane database of systematic reviews). Both medical subject heading (MeSH) terms used were "pyloric stenosis," "pyloromyotomy," "comparative studies," "open," "laparoscopic," and "postoperative complications.""
Reasoning: The information sources searched are described, but the date last searched is not reported.
[No]
P8
Quote: The full search strategy is not presented in the article.
Reasoning: The full electronic search strategy is not reported.
[No]
P9
Quote: "Potentially eligible studies were reviewed independently by two authors (MWNO, RB) for inclusion and exclusion criteria. Studies were included in the review if they were RCTs that compared the results of LP and OP in children with HPS with admission time after pyloromyotomy and postoperative complication rate as outcomes."
Reasoning: The process for selecting studies is described.
[Yes]
P10
Quote: "From the included studies, data on setting, methodological quality [according to the Cochrane handbook for systematic reviews of interventions (http://dcc.cochrane.org/sites/ dcc.cochrane.org/files/uploads/RCT)], population, and type of surgery were extracted by two authors independently, as well as data on primary and secondary outcome measures."
Reasoning: The data extraction process is described, including extraction in duplicate by two independent authors.
[Yes]
P11
Quote: "From the included studies, data on setting, methodological quality [according to the Cochrane handbook for systematic reviews of interventions (http://dcc.cochrane.org/sites/ dcc.cochrane.org/files/uploads/RCT)], population, and type of surgery were extracted by two authors independently, as well as data on primary and secondary outcome measures."
Reasoning: The types of data extracted are described (setting, quality, population, surgery type, outcome measures).
[Yes]
P12
Quote: "From the included studies, data on setting, methodological quality [according to the Cochrane handbook for systematic reviews of interventions (http://dcc.cochrane.org/sites/ dcc.cochrane.org/files/uploads/RCT)], population, and type of surgery were extracted by two authors independently, as well as data on primary and secondary outcome measures."
Reasoning: The Cochrane risk of bias tool was used to assess risk of bias in individual studies.
[Yes]
P13
Quotes: "The mean difference in time to full feed was significant (2.27 h, 95% CI -4.26 to -0.29 h) and the mean difference in postoperative hospital stay tended to be shorter (2.41 h, 95% CI -6.10 to 1.28 h), both in favor of LP."
"The mean time to full feeding in this article was less in the LP group (4.4 h) than in the OP group (8.9 h)."
Reasoning: The principal summary measures are mean differences with 95% confidence intervals.
[Yes]
P14
Quotes: See Figures 2-5 which present forest plots of the meta-analyses.
Reasoning: The results of each meta-analysis are presented with measures of consistency (I2 statistic).
[Yes]
P15
Quote: "Furthermore, to our knowledge there is no randomized clinical trial or systematic review that described (major) complications as a primary outcome, which should be appreciated together with the possible positive outcomes."
Reasoning: Risk of bias across studies (e.g. publication bias) was not assessed. The authors acknowledge the lack of RCTs with complications as a primary outcome.
[No]
P16
Quote: No additional analyses such as subgroup analyses or meta-regression are reported.
Reasoning: Additional analyses were not performed.
[NA]
P17
Quote: "The initial search yielded 361 potentially relevant articles, of which 346 articles were excluded because of failure to meet the inclusion criteria (Fig. 1). Fifteen full papers were retrieved for more information of which 11 studies were excluded from the systematic review. These excluded articles were not randomized controlled trials [5, 11, 16–18], consisted only of a meta-analysis [19], used different end points [20] or different treatment strategies [21] and a RCT in which no laparoscopy was performed. Four RCTs with a total of 502 patients (OP 255, LP 247) fulfilled the inclusion criteria and were analyzed in this review [6–8, 13]."
Reasoning: The number of studies screened, assessed for eligibility, and included in the review are reported, with reasons for exclusions. A flow diagram is also provided (Figure 1).
[Yes]
P18
Quote: "Study details and the quality check of all RCTs are given in Tables 1, 2, respectively."
Reasoning: The characteristics of each included study are provided in Tables 1 and 2, along with citations.
[Yes]
P19
Quote: "Study details and the quality check of all RCTs are given in Tables 1, 2, respectively."
Reasoning: The risk of bias assessments for each included study are reported in Table 2.
[Yes]
P20
Quotes: See Figures 2-5 which present forest plots with effect estimates and confidence intervals for each study and outcome.
Reasoning: For each study and outcome, the forest plots show the summary data for each group along with the effect estimates and confidence intervals.
[Yes]
P21
Quotes: See Figures 2-5 which present forest plots of the meta-analyses.
Reasoning: The results of each meta-analysis are presented with confidence intervals and measures of consistency (I2 statistic).
[Yes]
P22
Quote: No assessment of risk of bias across studies is reported.
Reasoning: The results of risk of bias assessment across studies are not presented.
[No]
P23
Quote: No additional analyses such as subgroup analyses or meta-regression are reported.
Reasoning: Additional analyses were not performed.
[NA]
P24
Quotes: "So far, the major postoperative complication rate after LP for HPS is not substantially higher than after OP. Because time to full feed and postoperative hospital stay are at best a few hours shorter after LP than after OP, the laparoscopic technique might be acknowledged as the standard of care if the major postoperative complication rate is low. Hence, this laparoscopic procedure should preferably be performed in centers with pediatric surgeons with expertise in this procedure."
"Despite this small benefit, LP can be acknowledged as the standard of care only if the included studies were of high quality and no heterogeneity between studies was found [12] and if the included studies were randomized and are therefore at higher risk of bias."
Reasoning: The main findings are summarized, including the strength of evidence, and their relevance to key groups (pediatric surgeons) is considered.
[Yes]
P25
Quotes: "Despite this small benefit, LP can be acknowledged as the standard of care only if the included studies were of high quality and no heterogeneity between studies was found [12] and if the included studies were randomized and are therefore at higher risk of bias."
"It is important to note that every hospital has different standardized protocols for a feeding regimen, which makes an objective comparison difficult."
Reasoning: Limitations at the study level (risk of bias, heterogeneity) and review level (different hospital protocols affecting comparisons) are discussed.
[Yes]
P26
Quote: "In any procedure that is introduced into daily surgical care, new problems can occur during and after surgery that were not recognized or foreseen by the surgeon and his team. This learning curve in the four RCTs plays an underestimated role in major complications seen in the laparoscopic group, which may also have influenced secondary outcomes such as postoperative hospital stay. In our opinion RCT that compares two procedures, the surgeon(s) should be beyond the learning curve(s) of both operations in order to make a valid comparison."
Reasoning: The authors provide a general interpretation of the results in the context of the learning curve for laparoscopic pyloromyotomy and implications for future research comparing the two procedures.
[Yes]
P27
Quote: "Disclosures Dr. M. W. N. Oomen, Dr. L. T. Hoekstra, Dr. R. Bakx, Dr. D. T. Ubbink, and Prof. Dr. H. A. Heij have no conflicts of interest or financial ties to disclose."
Reasoning: Sources of funding for the systematic review are not described, only that the authors have no conflicts of interest to disclose.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
0
|
0
|
0
|
1
|
1
|
1
|
0
|
NA
|
NA
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
NA
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
1
|
1
|
0
|
NA
|
NA
|
NA
|
NA
|
0
|
1
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
NA
|
NA
|
1
|
1
|
1
|
1
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
0
|
0
|
0
|
1
|
0
|
0
|
NA
|
NA
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
0
|
0
|
0
|
0
|
1
|
1
|
0
|
NA
|
NA
|
0
|
LLM response
21 quote(s) from
publication full text (mean similarity 98.3%)
A1. Was an 'a priori' design provided?
Quotes: "We adhered to PRISMA guidelines for this systematic review [6]. The PubMed database was searched for studies of children with EA and RAA published from January 1990 to December 2014."
Reasoning: The authors mention adhering to PRISMA guidelines, but do not specify an a priori protocol or pre-registered objectives.
[No]
A2. Was there duplicate study selection and data extraction?
Quotes: "Two independent authors extracted information related to each eligible study. The methodological quality of the studies was assessed with the level of evidence and the strength of guideline recommendations in diagnostic scales [7,8]."
Reasoning: Two independent authors extracted data, but no mention of a consensus procedure for disagreements.
[No]
A3. Was a comprehensive literature search performed?
Quotes: "The PubMed database was searched for original studies on children with EA and RAA. In each study, data were extracted for the following outcomes: number of patients, associated anomalies, type of surgical repair, morbidity and mortality rate."
Reasoning: Only one database (PubMed) was searched, with no supplementary sources.
[No]
A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion?
Quotes: No relevant quotes found.
Reasoning: No mention of including grey literature or unpublished studies.
[No]
A5. Was a list of studies (included and excluded) provided?
Quotes: "The initial PubMed search yielded 125 potentially relevant articles. Eight eligible articles met the inclusion criteria in the end. All were single-institution, retrospective studies, case reports or case series (class of evidence III and evidence rating scale E) [6]."
Reasoning: The number of included studies is stated, but no list of excluded studies is provided.
[No]
A6. Were the characteristics of the included studies provided?
Quotes: See Table 1 "Epidemiology of esophageal atresia associated with right aortic arch."
Reasoning: Study characteristics are provided in an aggregated form in Table 1.
[Yes]
A7. Was the scientific quality of the included studies assessed and documented?
Quotes: "The methodological quality of the studies was assessed with the level of evidence and the strength of guideline recommendations in diagnostic scales [7,8]."
Reasoning: The scientific quality was assessed using diagnostic scales.
[Yes]
A8. Was the scientific quality of the included studies used appropriately in formulating conclusions?
Quotes: No relevant quotes found.
Reasoning: The scientific quality is not explicitly considered in the analysis or conclusions.
[No]
A9. Were the methods used to combine the findings of studies appropriate?
[NA] - No meta-analysis was performed.
A10. Was the likelihood of publication bias assessed?
[NA] - No meta-analysis was performed.
A11. Was the conflict of interest included?
Quotes: "Appendix 1. Main authors' conclusions of the considered series."
Reasoning: Conflicts of interest are stated for the authors of the systematic review, but not for each included study.
[No]
P1. Title
Quotes: "The management of newborns with esophageal atresia and right aortic arch: A systematic review or still unsolved problem"
Reasoning: The title identifies the article as a systematic review.
[Yes]
P2. Abstract / Structured summary
Quotes: See the structured abstract on the first page.
Reasoning: A structured abstract is provided with labeled sections for background, aim, materials and methods, results, and conclusions.
[Yes]
P3. Introduction / Rationale
Quotes: "RAA is a rare anatomical variant in which the aortic arch is on the right side of the thorax instead of on the left. It is thought to occur in approximately 0.1% of the general population and in 1.8%–3.6% of children with EA [1,2,5]."
Reasoning: The rationale for the review is described in the context of the rarity of RAA in EA patients.
[Yes]
P4. Introduction / Objectives
Quotes: "This study provides a systematic review of epidemiology, diagnosis, management and short-term results of children with EA and RAA."
Reasoning: The objectives are clearly stated, but do not explicitly reference the PICOS framework.
[Yes]
P5. Methods / Protocol and registration
Quotes: "We adhered to PRISMA guidelines for this systematic review [6]."
Reasoning: Adherence to PRISMA is mentioned, but no protocol or registration number is provided.
[No]
P6. Methods / Eligibility criteria
Quotes: "Inclusion criteria were English language articles reporting diagnosis, management and outcomes of children with EA and RAA."
Reasoning: The eligibility criteria are briefly stated.
[Yes]
P7. Methods / Information sources
Quotes: "The PubMed database was searched for original studies on children with EA and RAA published from January 1990 to December 2014."
Reasoning: PubMed is stated as the only information source, with the date range specified.
[Yes]
P8. Methods / Search
Quotes: No relevant quotes found.
Reasoning: The full search strategy is not presented.
[No]
P9. Methods / Study selection
Quotes: See Figure 1 flow diagram.
Reasoning: The study selection process is illustrated in a PRISMA flow diagram.
[Yes]
P10. Methods / Data collection process
Quotes: "Two independent authors extracted information related to each eligible study."
Reasoning: Data was extracted independently in duplicate.
[Yes]
P11. Methods / Data items
Quotes: "In each study, data were extracted for the following outcomes: number of patients, associated anomalies, type of surgical repair, morbidity and mortality rate."
Reasoning: The data items collected are listed.
[Yes]
P12. Methods / Risk of bias in individual studies
Quotes: "The methodological quality of the studies was assessed with the level of evidence and the strength of guideline recommendations in diagnostic scales [7,8]."
Reasoning: Risk of bias was assessed using diagnostic scales.
[Yes]
P13. Methods / Summary measures
[NA] - No meta-analysis was performed.
P14. Methods / Synthesis of results
[NA] - No meta-analysis was performed.
P15. Methods / Risk of bias across studies
[NA] - No meta-analysis was performed.
P16. Methods / Additional analyses
[NA] - No meta-analysis was performed.
P17. Results / Study selection
Quotes: See Figure 1 flow diagram.
Reasoning: The study selection process and reasons for exclusions are shown in a flow diagram.
[Yes]
P18. Results / Study characteristics
Quotes: See Table 1 "Epidemiology of esophageal atresia associated with right aortic arch."
Reasoning: Study characteristics are provided for each included study.
[Yes]
P19. Results / Risk of bias within studies
Quotes: "Eight eligible articles met the inclusion criteria in the end. All were single-institution, retrospective studies, case reports or case series (class of evidence III and evidence rating scale E) [6]."
Reasoning: The level of evidence is reported for each included study.
[Yes]
P20. Results / Results of individual studies
Quotes: See Table 1 "Epidemiology of esophageal atresia associated with right aortic arch."
Reasoning: Results for individual studies are provided in Table 1.
[Yes]
P21. Results / Synthesis of results
[NA] - No meta-analysis was performed.
P22. Results / Risk of bias across studies
[NA] - No meta-analysis was performed.
P23. Results / Additional analysis
[NA] - No meta-analysis was performed.
P24. Discussion / Summary of evidence
Quotes: "The main conclusions on the approaches suggested in the eight studies selected are summarized in Appendix 1."
Reasoning: The main findings are summarized, but the strength of evidence is not explicitly stated.
[Yes]
P25. Discussion / Limitations
Quotes: "This systematic review had some inherent limitations. Firstly, it includes a relatively small number of patients, and many endpoints of the study could not be compared in a statistically significant way. Secondly, all eligible studies were retrospective case series without a control arm, and no randomized trials or comparative prospective studies could be included."
Reasoning: Limitations at the study and review level are discussed.
[Yes]
P26. Discussion / Conclusions
Quotes: "At this point, after the initial ligation, many authors considered it appropriate to attempt esophageal pouch dissection and completion of the primary anastomosis when technically feasible. If a long-gap EA is found or complete primary repair cannot be achieved safely, then an LT seems to be the more reasonable choice."
Reasoning: The authors provide an overall interpretation and implications for future management.
[Yes]
P27. Funding
Quotes: No relevant quotes found.
Reasoning: Sources of funding for the systematic review are not reported.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
1
|
1
|
1
|
0
|
NA
|
NA
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
0
|
1
|
0
|
0
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
0
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
1
|
1
|
0
|
NA
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
NA
|
0
|
1
|
0
|
0
|
0
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
1
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
1
|
0
|
0
|
0
|
1
|
1
|
1
|
NA
|
NA
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
0
|
0
|
1
|
1
|
1
|
1
|
NA
|
NA
|
0
|
LLM response
27 quote(s) from
publication full text (mean similarity 98.2%)
Here is the assessment of the systematic review using AMSTAR and PRISMA:
A1
Quote: "Purpose: Aim of this systematic review is to investigate the thoracic and cervical surgical approaches of H-type tracheo-esophageal fistula (TEF) according to the position of the fistula."
Reasoning: The research question and inclusion criteria are clearly stated in the purpose.
[Yes]
A2
Quotes: "Two independent authors extracted information related to the study. Methodological quality of the studies was assessed with the level of evidence and the strength of guideline recommendations in diagnosis scales [6,7]. For each study, data were extracted for three primary outcomes and three secondary outcomes. The primary outcomes were the number of treated patients, the study duration and the surgical approach. For open surgery group, the secondary outcomes were the level of the fistula, the use of contrast studies, the use of endoscopy, the cumulation of the fistula, the complications and the mortality. For thoracoscopic series, secondary outcome were the level of the fistula, the complications and the mortality, and many surgical details."
Reasoning: Two independent authors extracted the data and assessed study quality.
[Yes]
A3
Quotes: "For this systematic review we adhered to PRISMA guidelines [4,5]. The PubMed database (http://www.ncbi.nlm.nih.gov/pubmed/) was searched for studies on treatment of H-type TEF that were published since January 1977."
Reasoning: Only one database (PubMed) was searched, without any supplementary strategies.
[No]
A4
Quotes: "The following keywords were searched individually or in association: isolated trachea-esophageal fistula, H-type tracheo-esophageal fistula, N-type tracheo-esophageal fistula, cervicotomy, thoracotomy and thoracoscopy. The date of the last search was December 2012."
Reasoning: No mention of including grey literature or unpublished studies.
[No]
A5
Quote: "Fig. 1. Identification of studies from PubMed databases and inclusion in the systematic review."
Reasoning: A flow diagram is provided showing the number of included and excluded studies at each stage.
[Yes]
A6
Quotes: "For each study, data were extracted for three primary outcomes and three secondary outcomes. The primary outcomes were the number of treated patients, the study duration and the surgical approach. For open surgery group, the secondary outcomes were the level of the fistula, the use of contrast studies, the use of endoscopy, the cumulation of the fistula, the complications and the mortality. For thoracoscopic series, secondary outcome were the level of the fistula, the complications and the mortality, and many surgical details."
"The initial PubMed search yielded 185 potentially relevant articles. Finally, 22 eligible articles met the inclusion criteria and were divided into open or thoracoscopic surgery categories. All reviewed study were uncontrolled studies using retrospective data, such as case report or case series (classes of evidence III and rating scales of evidence E) [6]. No randomized-controlled trials or prospective studies comparing the different surgical approaches were found."
Reasoning: Key characteristics of the included studies like outcomes, study designs, number of patients are provided in aggregate form.
[Yes]
A7
Quotes: "Methodological quality of the studies was assessed with the level of evidence and the strength of guideline recommendations in diagnosis scales [6,7]."
"All reviewed study were uncontrolled studies using retrospective data, such as case report or case series (classes of evidence III and rating scales of evidence E) [6]."
Reasoning: The methodological quality was assessed using level of evidence scales, with the studies being rated as low quality (class III evidence).
[Yes]
A8
Quote: "The evidence base in regard to the treatment of H-type TEF, although not negligible, is poor and the skills and preferences of the surgeons guide the choice of the procedure."
Reasoning: The limitations of the evidence base are acknowledged when formulating the conclusions.
[Yes]
A9
Reasoning: This is a systematic review without a meta-analysis, so assessing the methods for combining studies is not applicable.
[NA]
A10
Reasoning: This is a systematic review without a meta-analysis, so assessing publication bias is not applicable.
[NA]
A11
Reasoning: The sources of funding and support for the systematic review are disclosed, but not for each individual included study.
[No]
P1
Quote: "Cervical/thoracotomic/thoracoscopic approaches for H-type congenital tracheo-esophageal fistula: A systematic review"
Reasoning: The title identifies the article as a systematic review.
[Yes]
P2
Reasoning: The abstract is not structured into distinct labeled sections like Background, Methods, Results, etc.
[No]
P3
Quote: "Tracheo-esophageal fistula (TEF) without esophageal atresia (H-type TEF) is a rare congenital malformation that accounts for about 4% of tracheo-esophageal malformations and has an incidence of around 1:50,000–80,000 births [1]. Surgical division of the fistula is curative, and the key to a successful repair is the pre-operatively identification of the level of the fistula with tracheoscopy, usually performed in collaboration with pediatric otorhinolaryngologists [2]. Although there is a general agreement that in the majority of H-type TEF cervicotomy is the approach of choice [3], when the fistula is located near the border between the neck and the thorax choosing the appropriate approach, cervical or thoracic is difficult."
Reasoning: Relevant background information is provided to describe the rationale for the review.
[Yes]
P4
Quote: "Purpose: Aim of this systematic review is to investigate the thoracic and cervical surgical approaches of H-type tracheo-esophageal fistula (TEF) according to the position of the fistula."
Reasoning: The objectives are explicitly stated, but do not mention all PICOS elements.
[No]
P5
Reasoning: No mention of a review protocol or registration number.
[No]
P6
Quotes: "Inclusion criteria were English and French articles that reported original data on treatment of newborn affected by trachea-esophageal fistula without esophageal atresia. Eligible study designs were case report, case series and review. The study selection process is presented in Fig. 1."
"Manuscripts finally included in the study were divided into two categories: open and thoracoscopic surgery."
Reasoning: Eligibility criteria related to study characteristics (study designs, population, intervention) and report characteristics (language) are specified.
[Yes]
P7
Quote: "For this systematic review we adhered to PRISMA guidelines [4,5]. The PubMed database (http://www.ncbi.nlm.nih.gov/pubmed/) was searched for studies on treatment of H-type TEF that were published since January 1977. The following keywords were searched individually or in association: isolated trachea-esophageal fistula, H-type tracheo-esophageal fistula, N-type tracheo-esophageal fistula, cervicotomy, thoracotomy and thoracoscopy. The date of the last search was December 2012."
Reasoning: The electronic database searched (PubMed) and date last searched are reported.
[Yes]
P8
Reasoning: The full search strategy is not presented for the database searched.
[No]
P9
Quote: "Fig. 1. Identification of studies from PubMed databases and inclusion in the systematic review."
Reasoning: The study selection process is described and shown in a flow diagram.
[Yes]
P10
Quotes: "Two independent authors extracted information related to the study. Methodological quality of the studies was assessed with the level of evidence and the strength of guideline recommendations in diagnosis scales [6,7]. For each study, data were extracted for three primary outcomes and three secondary outcomes."
Reasoning: The data extraction process is described, including two independent authors extracting the data.
[Yes]
P11
Quotes: "The primary outcomes were the number of treated patients, the study duration and the surgical approach. For open surgery group, the secondary outcomes were the level of the fistula, the use of contrast studies, the use of endoscopy, the cumulation of the fistula, the complications and the mortality. For thoracoscopic series, secondary outcome were the level of the fistula, the complications and the mortality, and many surgical details."
Reasoning: The variables for which data were sought are defined.
[Yes]
P12
Quotes: "Methodological quality of the studies was assessed with the level of evidence and the strength of guideline recommendations in diagnosis scales [6,7]."
Reasoning: The method of assessing risk of bias is described (using level of evidence scales).
[Yes]
P13
Reasoning: The principal summary measures are not explicitly stated.
[No]
P14
Reasoning: This is a systematic review without a meta-analysis, so methods for combining results are not applicable.
[NA]
P15
Reasoning: This is a systematic review without a meta-analysis, so assessing risk of bias across studies is not applicable.
[NA]
P16
Reasoning: No additional analyses are mentioned.
[No]
P17
Quote: "Fig. 1. Identification of studies from PubMed databases and inclusion in the systematic review."
Reasoning: A flow diagram is provided showing the number of studies screened, assessed for eligibility, included and excluded with reasons at each stage.
[Yes]
P18
Quotes: "The initial PubMed search yielded 185 potentially relevant articles. Finally, 22 eligible articles met the inclusion criteria and were divided into open or thoracoscopic surgery categories. All reviewed study were uncontrolled studies using retrospective data, such as case report or case series (classes of evidence III and rating scales of evidence E) [6]."
Reasoning: The characteristics of the included studies are presented, but individual study citations are not provided.
[No]
P19
Reasoning: Results of the risk of bias assessment for individual studies are not presented.
[No]
P20
Reasoning: Simple summary data for each group and effect estimates for each study are not provided.
[No]
P21
Reasoning: This is a systematic review without a meta-analysis, so results of meta-analyses are not applicable.
[NA]
P22
Reasoning: This is a systematic review without a meta-analysis, so results of risk of bias across studies are not applicable.
[NA]
P23
Reasoning: No additional analyses are mentioned.
[NA]
P24
Quotes: "The evidence base in regard to the treatment of H-type TEF, although not negligible, is poor and the skills and preferences of the surgeons guide the choice of the procedure."
"In these children thoracoscopy has proved to be a safe and effective technique, achieving outcome comparable to open surgery, but avoiding the long-term morbidity and scarring associated to thoracotomy."
Reasoning: The main findings are summarized, including their relevance to surgeons.
[Yes]
P25
Quote: "Conclusions: The evidence base in regard to the treatment of H-type fistula in children is poor, and as well stated by Tovar and Fragoso [31], in the absence of evidence-based strategies, "eminence-based" ones are legitimate. Further well-designed pre-operative diagnosis of the fistula, right cervicotomy seems to be the approach of choice in the majority of case, with the thoracic approach appropriate only for fistulae opening below T2."
Reasoning: Limitations of the evidence base are discussed.
[Yes]
P26
Quote: "Further well-designed prospective studies are required to take into account selection and performance bias, and the issue of confounding are strongly required."
Reasoning: Implications for future research are provided.
[Yes]
P27
Quote: "The authors have no financial relationships relevant to this article to disclose."
Reasoning: Sources of funding for the systematic review are disclosed.
[Yes]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
0
|
0
|
0
|
1
|
0
|
0
|
0
|
NA
|
NA
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
NA
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
0
|
0
|
0
|
NA
|
NA
|
NA
|
NA
|
1
|
0
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
NA
|
NA
|
0
|
0
|
0
|
0
|
NA
|
NA
|
NA
|
0
|
0
|
0
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
NA
|
NA
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
NA
|
NA
|
NA
|
0
|
LLM response
12 quote(s) from
publication full text (mean similarity 99.9%)
A1
"The objective of this study was to determine morbidity and mortality for this procedure."
The objective is stated, but there is no mention of a protocol, ethics approval, or a priori published research objectives.
[No]
A2
No relevant quotes found.
The study does not mention duplicate study selection and data extraction.
[No]
A3
"Medline, PubMed, National Library of Health and Google Scholarly articles from year 1997 to August 2011 were searched. Search terms used were [total] ([o]esophago-gastric/ gastro-[o]esophageal) (dissociation/disconnection/separation)."
The authors searched multiple databases and provided search terms, but did not supplement the search with other methods like reviewing references or consulting experts.
[No]
A4
No relevant quotes found.
The study does not mention whether they included or excluded studies based on publication status (i.e., grey literature).
[No]
A5
No relevant quotes found.
The study does not provide a list of included and excluded studies.
[No]
A6
"One hundred eighty-one cases were identified. One hundred seventeen were primary operations and 64 were rescue procedures. There were 29 (16.0%) early complications and 28 (15.5%) late complications with 6 (3.3%) deaths related to the procedure of a total of 35 deaths. Twenty-one patients (11.6%) required re-operation in the study periods."
The study provides some aggregate characteristics of included studies like number of patients, procedures, complications and deaths, but does not give a full table of study characteristics.
[No]
A7
No relevant quotes found.
The study does not mention assessing the quality of included studies.
[No]
A8
[NA]
A9
[NA]
A10
[NA]
A11
No relevant quotes found.
The study does not report the funding sources of the included studies.
[No]
P1
"Morbidity and mortality in total esophagogastric dissociation: A systematic review"
The title identifies the article as a systematic review.
[Yes]
P2
The abstract is structured with labeled sections for Background/Purpose, Methods, Results, and Conclusions.
The abstract provides a structured summary with most of the required elements, but is missing a few like the registration number.
[Yes]
P3
"Total esophagogastric dissociation (TOGD) is an anti-reflux procedure originally described as a "rescue" procedure for use in children with neurological impairment (NI) by Bianchi [1] in 1997. Its use has subsequently been broadened to include neurologically normal children and adults with NI [2]. TOGD is now used as both a primary surgical procedure and as "rescue" therapy following failed fundoplication."
The introduction describes the rationale for the review in the context of what is already known about the procedure.
[Yes]
P4
No relevant quotes found.
The introduction does not provide an explicit statement of the review questions with reference to PICOS.
[No]
P5
No relevant quotes found.
The methods do not indicate if a review protocol exists or provide a registration number.
[No]
P6
No relevant quotes found.
The methods do not specify the study characteristics and report characteristics used as eligibility criteria.
[No]
P7
"Medline, PubMed, National Library of Health and Google Scholarly articles from year 1997 to August 2011 were searched."
The methods describe the databases searched but do not provide the date last searched.
[No]
P8
No relevant quotes found.
The methods do not present the full search strategy for any of the databases.
[No]
P9
No relevant quotes found.
The methods do not state the process for selecting studies.
[No]
P10
No relevant quotes found.
The methods do not describe the data extraction process.
[No]
P11
No relevant quotes found.
The methods do not list and define the variables for which data were sought.
[No]
P12
No relevant quotes found.
The methods do not describe assessing risk of bias in individual studies.
[No]
P13
[NA]
P14
[NA]
P15
[NA]
P16
[NA]
P17
No relevant quotes found.
The results do not provide a flow diagram or report the number of studies screened, assessed for eligibility, included, and excluded with reasons.
[No]
P18
"One hundred eighty-one patients who had undergone TOGD were identified from 10 articles, personal communication with authors of these articles and data held at our institution (Table 1, Fig. 1) [2–6,9–13]. A two-center study combining data from Manchester and Rome was analyzed to gain the Rome data [5]."
The results mention the total number of patients and articles, and provide citations, but do not present the extracted study characteristics for each study.
[No]
P19
No relevant quotes found.
The results do not present data on risk of bias for each included study.
[No]
P20
No relevant quotes found.
The results do not present the individual study data for each intervention group.
[No]
P21
[NA]
P22
[NA]
P23
[NA]
P24
"We have identified 181 cases of TOGD in the literature and from our own experience. There are nine cases reported of TOGD use in adults but they have not been included here as the focus is on children."
The discussion summarizes the main findings but does not address the strength of evidence for each outcome.
[No]
P25
"Complication rates following fundoplication are difficult to compare between studies as it is not always apparent what they have included as a complication. Open fundoplication does appear to carry a higher complication rate as does fundoplication when undertaken in NI children."
The discussion mentions some limitations in comparing complication rates between studies, but does not discuss limitations at the review level.
[No]
P26
No relevant quotes found.
The discussion does not provide a general interpretation of the results in the context of other evidence or discuss implications for future research.
[No]
P27
"The authors thank Dr. Paul D Danielson, Dr. Saleem Islam and Mr. Adrian Bianchi for providing details of cases performed since their publications."
The article acknowledges individuals who provided data, but does not describe sources of funding for the systematic review itself.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
0
|
0
|
1
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
NA
|
NA
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
0
|
1
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
NA
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
0
|
0
|
0
|
NA
|
NA
|
NA
|
NA
|
0
|
0
|
0
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
NA
|
NA
|
0
|
0
|
0
|
0
|
NA
|
NA
|
NA
|
1
|
0
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
NA
|
NA
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
NA
|
NA
|
0
|
LLM response
13 quote(s) from
publication full text (mean similarity 99.8%)
A1
"The purpose of this review is to update the use of MIS in pediatric oncological surgery over the past five years."
The review purpose is stated, but there is no mention of an a priori protocol or pre-specified objectives.
[No]
A2
No mention of duplicate study selection or data extraction.
[No]
A3
"The authors conducted a systematic review of papers published between 2009 and 2014 focusing on indications and results of the technique."
Only one database (PubMed) was searched from 2009-2014. No search terms provided.
[No]
A4
No mention of including grey literature.
[No]
A5
No list of included and excluded studies provided.
[No]
A6
"References for this review were identified by PubMed searches using appropriate search terms for each section ("minimally invasive surgery," "laparoscopy," "thoracoscopy," "childhood/children/pediatric cancer")."
Some study characteristics like search terms and populations are provided in aggregate, but no details on individual included studies.
[No]
A7
No mention of assessing study quality.
[No]
A8
No assessment of study quality, so quality could not be used to formulate conclusions.
[No]
A9
"Case control studies comparing MIS to open approach have been published for the first time in more classical indications such as neurogenic tumors, while robot-assisted procedure has shown concern in results about its early experience in solid tumors."
Qualitative statements are made about the results, but no quantitative synthesis was performed.
[NA]
A10
No assessment of publication bias.
[NA]
A11
"Conflict of Interest
None."
The review declares no conflicts of interest, but the funding sources of the included studies are not reported.
[No]
P1
"Minimally Invasive Surgery in Childhood Cancer: A Challenging Future"
The title identifies the article as a review on minimally invasive surgery in childhood cancer.
[Yes]
P2
The abstract has labeled sections for background, methods, results, and conclusion. However, some key elements like participants, interventions, appraisal and synthesis methods are missing.
[No]
P3
"Minimally invasive surgery (MIS) has emerged as an alternative to open approach for cancer diagnosis in children ∼20 years ago, but only recently for tumor resection."
The introduction provides rationale for the review in the context of the emergence of MIS in pediatric oncology.
[Yes]
P4
"The purpose of this review is to update the use of MIS in pediatric oncological surgery over the past five years."
The introduction states the review purpose, but does not explicitly mention the PICOS elements.
[No]
P5
No mention of a review protocol or registration.
[No]
P6
"References for this review were identified by PubMed searches using appropriate search terms for each section ("minimally invasive surgery," "laparoscopy," "thoracoscopy," "childhood/children/pediatric cancer"). Articles were also identified by searching the authors' own files. Only papers published in English language were reviewed."
Eligibility criteria related to databases, years, search terms, language are provided. No rationale is given.
[No]
P7
"References for this review were identified by PubMed searches using appropriate search terms for each section ("minimally invasive surgery," "laparoscopy," "thoracoscopy," "childhood/children/pediatric cancer"). Articles were also identified by searching the authors' own files."
PubMed and authors' files were searched, but no dates of coverage or last search date are provided.
[No]
P8
No search strategy provided.
[No]
P9
No description of the study selection process.
[No]
P10
No description of the data collection process.
[No]
P11
No list of variables for which data were sought.
[No]
P12
No description of assessing risk of bias in individual studies.
[No]
P13
No summary measures specified, as no meta-analysis was performed.
[NA]
P14
No description of methods for combining results, as no meta-analysis was performed.
[NA]
P15
No mention of assessing risk of bias across studies.
[NA]
P16
No description of any additional analyses.
[NA]
P17
No PRISMA flow diagram provided showing the number of studies screened, included and excluded.
[No]
P18
No details on individual study characteristics provided.
[No]
P19
No assessment of risk of bias of individual studies reported.
[No]
P20
Some qualitative statements are made summarizing the results of individual studies, but no quantitative summary data or effect estimates are provided.
[No]
P21
No meta-analysis was performed.
[NA]
P22
No assessment of risk of bias across studies was reported.
[NA]
P23
No additional analyses were reported.
[NA]
P24
"MIS is a promising method for removal of thoracic and abdominal malignancies as long as oncological principles are strictly followed. Long-term follow-up is mandatory to further delineate objective indications."
The discussion summarizes the main findings and their relevance to clinicians.
[Yes]
P25
"Shorter postoperative course, shorter hospital stay, less use of narcotics, early first oral intake, early recovery, less bowel adhesion formation, and decreased risk of wound infections and incisional hernias allow early adjuvant treatment with either chemotherapy or radiotherapy, which is the ultimate goal in the battle against cancer."
Some limitations related to shorter postoperative course and early adjuvant therapy are discussed. Review-level limitations like incomplete retrieval of studies and reporting bias are not mentioned.
[No]
P26
"MIS, regardless of the approach—thoracoscopy, laparoscopy, retroperitoneoscopy, robot-assisted—is a new field in pediatric solid tumors with no randomized trials to date. Only case control studies have shown its noninferiority to open approach, but in experienced hands and with the absolute respect to oncological rules. MIS is a tempting procedure needing further development to precisely define its objective indications and limits in oncological pediatric surgery."
The conclusion provides a general interpretation and implications for future research.
[Yes]
P27
"Conflict of Interest
None."
The review's funding source is reported, but the role of the funder is not described.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
1
|
1
|
1
|
0
|
1
|
0
|
0
|
1
|
0
|
1
|
0
|
0
|
NA
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
0
|
1
|
0
|
0
|
0
|
1
|
1
|
1
|
1
|
1
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
0
|
1
|
0
|
0
|
0
|
0
|
0
|
0
|
1
|
1
|
1
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
NA
|
NA
|
0
|
0
|
0
|
0
|
1
|
NA
|
NA
|
1
|
1
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
1
|
0
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
0
|
0
|
0
|
0
|
1
|
1
|
1
|
1
|
NA
|
0
|
LLM response
24 quote(s) from
publication full text (mean similarity 98.6%)
A1
"A systematic literature search was undertaken, using Medline and Pubmed, in order to identify relevant articles. Random effects models were used to estimate pooled complication rates. Meta-regression was performed for each outcome by using mixed effects models with type of hypospadias (primary distal, primary proximal and secondary) as predictors."
The authors describe using a systematic search and pre-specified methods for data synthesis and analysis.
[Yes]
A2
No relevant quotes found. The authors do not mention using at least two independent reviewers for study selection and data extraction.
[No]
A3
"Medline and Pubmed were searched in order to identify articles published between 1994 and 2012. The search terms 'tubularized incised plate urethroplasty/Snodgrass repair/ technique and outcomes/complications ± follow-up/long term follow-up' were used."
The authors searched Medline and PubMed, but do not mention supplementing the search with other methods like reviewing references or consulting experts.
[No]
A4
No relevant quotes found. The authors do not mention whether they included grey literature.
[No]
A5
No relevant quotes found. The authors do not provide a list of included and excluded studies.
[No]
A6
"The following data were extracted independently from each article by two reviewers (M.P and P.C): study size; degree of hypospadias (classified by meatal location: distal — midshaft distally, proximal — proximal shaft proximally); primary or secondary repair; repair type (standard vs modified TIP); modification (if used); mean length of follow-up; study duration; geographical location; and rates of meatal stenosis, fistula, urethral stricture and unplanned re-operation to treat complications."
The authors provide aggregate study characteristics in the methods section.
[Yes]
A7
"Of the 189 studies identified, 49 studies (4675 patients) were included in the analysis. Fistula and re-operation rates were significantly higher in secondary repairs (15.5% and 23.3%) compared to primary proximal (10.3% and 12.2%) and primary distal (5.7% and 4.5%) (P = 0.045 and P < 0.001, respectively). Meatal stenosis rates were significantly higher in primary proximal repairs, with follow-up >1 year (12.7%). Comparison of geographical location showed that complication rates for all but one variable were significantly lower in North America when compared to Europe and the rest of the world."
The authors assessed study quality by comparing complication rates by repair type, follow-up duration, and geographical location.
[Yes]
A8
"This meta-analysis shows the lowest complication rates for the TIP repair when it is applied to primary distal hypospadias, with mean rates of meatal stenosis at 3.6% (range 1.7–7.4%), urethral stricture at 1.3% (range 0.8–2.2%), fistula at 5.7% (range 4.0–8.2%) and re-operation at 4.5% (range 2.7–7.5%). The fistula rate is higher than the reoperation rate as one paper reports spontaneous healing of three fistulae [24]. Several studies, including the review paper by Wilkinson et al. [66] reported a lower fistula rate but similar meatal stenosis rates, and Snodgrass reported a 2% fistula rate for the distal repairs [67]. It should be noted that the mode of evaluating complications varied between papers, with no standardised method of assessment. Performing a meta-analysis of the published data has given a pooled estimate of the complication rates assessed, by encompassing all the documented results showing that the TIP repair is a transferable technique that provides good outcomes in primary distal hypospadias."
The authors consider the study quality assessment in their conclusions, noting the lowest complication rates are for primary distal repairs but acknowledging the variability in how complications were evaluated across studies.
[Yes]
A9
"Analyses were conducted using random and mixed-effects models, with the restricted maximum likelihood (REML) estimator. Proportions were expressed on the logit scale for analysis, and 0.5 was added to the numerator and denominators of outcomes with no events to prevent infinities. Estimated complication rates were calculated using random effects models for each type of hypospadias (primary distal, primary proximal and secondary), location (grouped into North America, Europe and rest of the world), and modified vs standard TIP repair."
The authors used appropriate methods to combine the findings, using random effects models and transforming proportions to the logit scale for analysis.
[Yes]
A10
No relevant quotes found. The authors do not mention assessing publication bias.
[NA]
A11
"None of the authors have any conflicts of interest or funding to declare."
The authors report no conflicts of interest for the systematic review, but do not report on conflicts of interest for the included primary studies.
[No]
P1
"Meta-analysis of complication rates of the tubularized incised plate (TIP) repair"
The title identifies the article as a meta-analysis.
[Yes]
P2
The abstract contains structured sections for objective, materials and methods, results, and conclusions.
[Yes]
P3
"Over 300 methods of surgical repair have been described for the correction of hypospadias, with no one procedure accepted as the gold standard for each degree of hypospadias. First described in 1994 by Snodgrass [1], the tubularized incised plate (TIP) urethroplasty has become the most popular technique for distal hypospadias [2,3]. Originally described for correction of distal hypospadias, it has also been applied to more severe proximal forms."
The introduction describes the rationale for the review in the context of existing literature on hypospadias repair techniques.
[Yes]
P4
"To determine overall complication rates of the tubularized incised plate (TIP) repair and assess the effects of technical modifications, length of followup and geographical location of reported results."
The objective statement specifies the review questions.
[Yes]
P5
No relevant quotes found. The authors do not mention the existence of a review protocol or registration.
[No]
P6
"The following data were extracted independently from each article by two reviewers (M.P and P.C): study size; degree of hypospadias (classified by meatal location: distal — midshaft distally, proximal — proximal shaft proximally); primary or secondary repair; repair type (standard vs modified TIP); modification (if used); mean length of follow-up; study duration; geographical location; and rates of meatal stenosis, fistula, urethral stricture and unplanned re-operation to treat complications. Where studies contained distal and proximal repairs and/or modified and standard techniques and/or primary and secondary repairs, the data were entered only if these were separable."
The methods section specifies the study characteristics and report characteristics used as eligibility criteria.
[Yes]
P7
"Medline and Pubmed were searched in order to identify articles published between 1994 and 2012."
The information sources and dates of coverage are described, but the date last searched is not provided.
[No]
P8
No relevant quotes found. The authors do not present the full search strategy.
[No]
P9
"Of the 189 studies identified, 49 studies (4675 patients) were included in the analysis."
The number of included studies is provided, but the full study selection process is not described.
[No]
P10
"The following data were extracted independently from each article by two reviewers (M.P and P.C)"
The data extraction process is described.
[Yes]
P11
"The following data were extracted independently from each article by two reviewers (M.P and P.C): study size; degree of hypospadias (classified by meatal location: distal — midshaft distally, proximal — proximal shaft proximally); primary or secondary repair; repair type (standard vs modified TIP); modification (if used); mean length of follow-up; study duration; geographical location; and rates of meatal stenosis, fistula, urethral stricture and unplanned re-operation to treat complications."
The data items collected are listed.
[Yes]
P12
"Of the 189 studies identified, 49 studies (4675 patients) were included in the analysis. Fistula and re-operation rates were significantly higher in secondary repairs (15.5% and 23.3%) compared to primary proximal (10.3% and 12.2%) and primary distal (5.7% and 4.5%) (P = 0.045 and P < 0.001, respectively). Meatal stenosis rates were significantly higher in primary proximal repairs, with follow-up >1 year (12.7%). Comparison of geographical location showed that complication rates for all but one variable were significantly lower in North America when compared to Europe and the rest of the world."
The authors assessed study quality by comparing complication rates by repair type, follow-up duration, and geographical location.
[Yes]
P13
"Proportions were expressed on the logit scale for analysis, and 0.5 was added to the numerator and denominators of outcomes with no events to prevent infinities."
The principal summary measures (proportions) are stated.
[Yes]
P14
"Analyses were conducted using random and mixed-effects models, with the restricted maximum likelihood (REML) estimator."
The methods for combining results are described.
[Yes]
P15
No relevant quotes found. The authors do not mention assessing risk of bias across studies.
[NA]
P16
No relevant quotes found. The authors do not describe any additional analyses.
[NA]
P17
"Of the 189 articles that were identified, 49 studies (4675 patients) were included in the analysis."
The number of studies included is provided, but a full study flow diagram is not presented.
[No]
P18
No relevant quotes found. The authors do not present the characteristics of individual included studies.
[No]
P19
No relevant quotes found. The authors do not present data on risk of bias for individual studies.
[No]
P20
No relevant quotes found. The authors do not present the results for individual studies.
[No]
P21
"Fistula rates were significantly higher in secondary repairs (mean 15.5%, range 12.1–19.6%) compared to primary proximal (mean 10.3%, range 6.3–16.3%) and primary distal (mean 5.7%, range 4.0–8.2%) (P = 0.005). Reoperation rates were significantly higher in the secondary repairs (mean 23.3%, range 18.5–28.9%) compared to primary proximal (mean 12.2%, range 7.7–18.6%) and primary distal repairs (mean 4.5%, range 2.7–7.5%) (P < 0.001). Meatal stenosis rates were higher in secondary repairs (mean 8.3%, range 3.9–16.7%) compared to primary proximal (mean 4.4%, range 3.8–5.2%) and primary distal repairs (mean 3.6%, range 1.7–7.4%), as were urethral stricture rates (for secondary repairs: mean 3.0%, range 1.6–5.7% for secondary repairs; mean 2.0%, range 1.0–4.0%; and for primary distal repairs mean 1.3%, range 0.8–2.2%, respectively)."
The results of the meta-analysis are presented, including confidence intervals and p-values.
[Yes]
P22
No relevant quotes found. The authors do not present results of risk of bias across studies.
[NA]
P23
No relevant quotes found. The authors do not report any additional analyses.
[NA]
P24
"This meta-analysis shows the lowest complication rates for the TIP repair when it is applied to primary distal hypospadias, with mean rates of meatal stenosis at 3.6% (range 1.7–7.4%), urethral stricture at 1.3% (range 0.8–2.2%), fistula at 5.7% (range 4.0–8.2%) and re-operation at 4.5% (range 2.7–7.5%). The fistula rate is higher than the reoperation rate as one paper reports spontaneous healing of three fistulae [24]. Several studies, including the review paper by Wilkinson et al. [66] reported a lower fistula rate but similar meatal stenosis rates, and Snodgrass reported a 2% fistula rate for the distal repairs [67]."
The authors summarize the main findings in the discussion.
[Yes]
P25
"It should be noted that the mode of evaluating complications varied between papers, with no standardised method of assessment. Performing a meta-analysis of the published data has given a pooled estimate of the complication rates assessed, by encompassing all the documented results showing that the TIP repair is a transferable technique that provides good outcomes in primary distal hypospadias."
The authors discuss limitations at the study level (variability in complication assessment) and review level (lack of standardized outcome measures).
[Yes]
P26
"In primary proximal repairs, there are higher complication rates for all variables, with fistula and re-operation rates over 10%. Very poor documentation of pre-operative meatal location and postoperative chordee precluded assessment of this for the primary proximal repairs, even though this is likely to be a significant outcome measure. In the United Kingdom, in order to decrease the chance of complications many surgeons would opt to perform a staged repair for this degree of hypospadias."
The authors provide a general interpretation of the results in the context of other evidence and implications for practice.
[Yes]
P27
"None of the authors have any conflicts of interest or funding to declare."
The authors state they have no conflicts of interest or funding, but do not describe sources of funding or support for the systematic review.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
0
|
0
|
0
|
1
|
1
|
1
|
1
|
NA
|
NA
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
NA
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
1
|
1
|
1
|
NA
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
NA
|
0
|
0
|
0
|
0
|
NA
|
0
|
NA
|
1
|
1
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
1
|
0
|
0
|
1
|
1
|
1
|
NA
|
NA
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
0
|
0
|
0
|
1
|
1
|
NA
|
NA
|
0
|
LLM response
17 quote(s) from
publication full text (mean similarity 97%)
1
quote(s) from the LLM prompt briefing (mean similarity 48.9%) -
were instructions quoted (ok) or examples (unwanted beahviour)?
A1. Was an 'a priori' design provided?
Quote: "The American Pediatric Surgical Association (APSA) Outcomes and Evidence Based Practice (OEBP) committee selected the following questions for this systematic review:"
The research questions were established a priori by the APSA OEBP committee.
[Yes]
A2. Was there duplicate study selection and data extraction?
Quote: "Studies selected for inclusion were critically appraised and ranked on their level of evidence based on the type of study (retrospective or prospective, randomized or not) per The Oxford Centre for Evidence Based Medicine (Table 1) [3], which also guided the recommendations generated for each question. Data compiled for each article included sample size, description of the procedures performed or medications used, method of ventilation, use of ECMO, timing of repair, outcomes including mortality and morbidity, and type of patch used."
Two authors independently selected studies and extracted data.
[Yes]
A3. Was a comprehensive literature search performed?
Quote: "Separate search terms were applied for each question using the MEDLINE, Embase, Cochrane, and Web of Science databases. Searches were limited to articles published in the English language from January 1, 1980 through January 31, 2014."
At least 2 electronic databases were searched with key terms from 1980-2014.
[Yes]
A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion?
No mention of including grey literature or unpublished studies.
[No]
A5. Was a list of studies (included and excluded) provided?
No list of included or excluded studies was provided.
[No]
A6. Were the characteristics of the included studies provided?
Quote: "A total of 3097 abstracts underwent initial title screening. Of these, 189 abstracts were selected for in-depth review of the abstract and/or full manuscript. We selected 98 of these manuscripts for the systematic review (Fig. 1). Most of the selected articles represented single institution experiences and large case series."
The number of included studies and some study characteristics were provided in aggregate form, but no table with detailed characteristics of each included study was provided.
[No]
A7. Was the scientific quality of the included studies assessed and documented?
Quote: "Studies selected for inclusion were critically appraised and ranked on their level of evidence based on the type of study (retrospective or prospective, randomized or not) per The Oxford Centre for Evidence Based Medicine (Table 1) [3], which also guided the recommendations generated for each question."
The level of evidence of included studies was assessed using the Oxford CEBM criteria and used to guide recommendations.
[Yes]
A8. Was the scientific quality of the included studies used appropriately in formulating conclusions?
Quote: "Based on level 2 evidence, iNO cannot be recommended to routinely treat PHTN in CDH patients (Grade C recommendation)"
The level of evidence was considered when making recommendations.
[Yes]
A9. Were the methods used to combine the findings of studies appropriate?
The systematic review did not perform any quantitative synthesis or meta-analysis.
[NA]
A10. Was the likelihood of publication bias assessed?
The systematic review did not assess publication bias.
[NA]
A11. Was the conflict of interest included?
Conflicts of interest for the systematic review authors were reported, but not for the included studies.
[No]
P1. Title
Quote: "Management of congenital diaphragmatic hernia: A systematic review from the APSA outcomes and evidence based practice committee"
The title identifies the article as a systematic review.
[Yes]
P2. Abstract
The abstract is structured with labeled sections for background, methods, results, and conclusions.
[Yes]
P3. Introduction / Rationale
Quote: "Despite significant advances in neonatal and surgical care, the management of newborns with congenital diaphragmatic hernia (CDH) remains a challenge. Significant variations in approach exist with regard to the use of antenatal steroids, ventilation modes, timing of repair, and pulmonary hypertension, the use of extra-corporeal membrane oxygenation (ECMO), and the timing and type of surgical repair [1]."
The introduction describes the rationale for the review in the context of variations in CDH management.
[Yes]
P4. Introduction / Objectives
Quote: "The American Pediatric Surgical Association (APSA) Outcomes and Evidence Based Practice (OEBP) committee selected the following questions for this systematic review: 1. What is the optimal ventilator strategy for a newborn with CDH? 2. What is the best way to manage CDH-associated pulmonary hypertension (PHTN)? 3. Is there benefit to the use of pre- or postnatal corticosteroids? 4. Which mode of ECMO is best for CDH, and what is the optimal duration of treatment with ECMO? 5. What is the optimal technique to repair CDH (open versus minimally invasive) and which type of patch has the best outcome? 6. Is early repair or late repair of CDH better?"
The introduction provides explicit questions being addressed.
[Yes]
P5. Methods / Protocol and registration
No mention of a protocol or registration number.
[No]
P6. Methods / Eligibility criteria
Quote: "Studies that did not address the neonatal population were excluded, as were opinion pieces, case reports, and editorial review articles (other than systematic reviews or meta analyses). The automated searches were supplemented by a manual search of additional references from the bibliographies of included studies."
Eligibility criteria regarding study design, population, and supplemental searches were described.
[Yes]
P7. Methods / Information sources
Quote: "Separate search terms were applied for each question using the MEDLINE, Embase, Cochrane, and Web of Science databases. Searches were limited to articles published in the English language from January 1, 1980 through January 31, 2014."
Databases searched and dates of coverage were reported.
[Yes]
P8. Methods / Search
No full search strategy was provided.
[No]
P9. Methods / Study selection
Quote: "Studies that did not address the neonatal population were excluded, as were opinion pieces, case reports, and editorial review articles (other than systematic reviews or meta analyses). The automated searches were supplemented by a manual search of additional references from the bibliographies of included studies."
The process for selecting studies was described.
[Yes]
P10. Methods / Data collection process
Quote: "Studies selected for inclusion were critically appraised and ranked on their level of evidence based on the type of study (retrospective or prospective, randomized or not) per The Oxford Centre for Evidence Based Medicine (Table 1) [3], which also guided the recommendations generated for each question. Data compiled for each article included sample size, description of the procedures performed or medications used, method of ventilation, use of ECMO, timing of repair, outcomes including mortality and morbidity, and type of patch used."
The data extraction process was described.
[Yes]
P11. Methods / Data items
Quote: "Data compiled for each article included sample size, description of the procedures performed or medications used, method of ventilation, use of ECMO, timing of repair, outcomes including mortality and morbidity, and type of patch used."
The data items collected were listed.
[Yes]
P12. Methods / Risk of bias in individual studies
Quote: "Studies selected for inclusion were critically appraised and ranked on their level of evidence based on the type of study (retrospective or prospective, randomized or not) per The Oxford Centre for Evidence Based Medicine (Table 1) [3], which also guided the recommendations generated for each question."
Risk of bias was assessed using the Oxford CEBM levels of evidence.
[Yes]
P13. Methods / Summary measures
No summary measures were specified, as no quantitative synthesis was performed.
[NA]
P14. Methods / Synthesis of results
No quantitative synthesis or meta-analysis was performed.
[NA]
P15. Methods / Risk of bias across studies
No assessment of risk of bias across studies, such as publication bias, was reported.
[No]
P16. Methods / Additional analyses
No additional analyses were reported.
[NA]
P17. Results / Study selection
Quote: "A total of 3097 abstracts underwent initial title screening. Of these, 189 abstracts were selected for in-depth review of the abstract and/or full manuscript. We selected 98 of these manuscripts for the systematic review (Fig. 1)."
The numbers of studies screened and included were reported, but no flow diagram was provided.
[No]
P18. Results / Study characteristics
Quote: "Most of the selected articles represented single institution experiences and large case series."
Some aggregate study characteristics were provided but not for each individual study.
[No]
P19. Results / Risk of bias within studies
The Oxford CEBM levels of evidence were used to assess risk of bias but results were not presented for each individual study.
[No]
P20. Results / Results of individual studies
Results for individual studies were not provided, only a narrative summary.
[No]
P21. Results / Synthesis of results
No meta-analysis was performed.
[NA]
P22. Results / Risk of bias across studies
No assessment of risk of bias across studies was reported.
[No]
P23. Results / Additional analysis
No additional analyses were reported.
[NA]
P24. Discussion / Summary of evidence
The discussion summarized the main findings and graded the strength of evidence for each key question.
[Yes]
P25. Discussion / Limitations
Quote: "Limitations in the data available in the literature precluded a meta-analysis of iNO use in CDH infants based on the NINOS criteria."
Some limitations of the evidence were acknowledged.
[Yes]
P26. Discussion / Conclusions
The conclusions provided a general interpretation and implications for future research.
[Yes]
P27. Funding
Quote: "The authors declare no conflicts of interest."
Sources of funding for the systematic review were not clearly described.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
0
|
0
|
1
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
1
|
0
|
NA
|
NA
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
NA
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
0
|
0
|
0
|
NA
|
NA
|
NA
|
NA
|
0
|
0
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
NA
|
NA
|
0
|
1
|
0
|
0
|
NA
|
NA
|
NA
|
1
|
0
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
0
|
0
|
0
|
1
|
0
|
0
|
NA
|
NA
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
NA
|
NA
|
NA
|
0
|
LLM response
13 quote(s) from
publication full text (mean similarity 99.5%)
A1
Quote: "A systematic review of the contemporary urological citations was conducted using the National Library of Medicine (PubMed) search engine. We included only those papers that discussed original series of patients in this review."
Reasoning: The authors mention conducting a systematic review using PubMed, but do not explicitly state that research questions and inclusion criteria were established a priori.
[No]
A2
Quotes: "Demographic information, including patient age, gender, presenting symptoms, number of URS procedures performed and stone-free rate, were abstracted from the papers reviewed. The data are presented in Table 1."
"Additionally, information about endoscopic instrumentation used by the authors and currently available was documented from the papers and also from the manufacturers' website."
Reasoning: The authors abstracted data from the papers reviewed and documented information, but do not mention a duplicate study selection and data extraction process.
[No]
A3
Quote: "A systematic review of the contemporary urological citations was conducted using the National Library of Medicine (PubMed) search engine."
Reasoning: Only one electronic database (PubMed) was searched.
[No]
A4
Reasoning: The inclusion of grey literature is not mentioned.
[No]
A5
Reasoning: A list of included and excluded studies is not provided.
[No]
A6
Quote: "A total of 27 papers that met the inclusion criteria for this review were identified and the data were abstracted. Over the past 20 years, the results of 832 pediatric patients (mean age, 9.4 years) managed with URS to treat stones have been published in the urological literature."
Reasoning: Aggregate characteristics of the included studies like number of patients and mean age are provided, but more details like ranges of characteristics are not reported.
[No]
A7
Reasoning: The scientific quality of the included studies was not assessed.
[No]
A8
Reasoning: Not applicable as the scientific quality was not assessed (A7).
[NA]
A9
Reasoning: Not applicable as this is a systematic review without a meta-analysis.
[NA]
A10
Reasoning: Not applicable as this is a systematic review without a meta-analysis.
[NA]
A11
Reasoning: Conflicts of interest are not reported for the systematic review or the included studies.
[No]
P1
Quote: "Ureteroscopy: The standard of care in the management of upper tract urolithiasis in children"
Reasoning: The title identifies the article as a systematic review.
[Yes]
P2
Quote: See the structured abstract on page 1.
Reasoning: A structured abstract with labeled sections of Objectives, Materials and Methods, Results, and Conclusions is provided.
[Yes]
P3
Quote: "Advances in technology and the continued evolution in the design of ureteroscopes now permit a primary endoscopic approach to the upper urinary tract of pediatric patients on a routine basis to treat a diverse group of conditions that include urolithiasis, hematuria and strictures."
Reasoning: The introduction describes the rationale for the review in the context of advances in ureteroscopy technology.
[Yes]
P4
Quote: "The purpose of this review article is to determine whether the safety and efficacy of URS now warrant it being considered the standard of care and the first line of therapy in the management of pediatric urolithiasis."
Reasoning: The introduction provides an explicit statement of the review question.
[Yes]
P5
Reasoning: The existence of a review protocol is not mentioned.
[No]
P6
Quote: "A total of 27 papers that met the inclusion criteria for this review were identified and the data were abstracted."
Reasoning: The inclusion criteria are not specified.
[No]
P7
Quote: "A systematic review of the contemporary urological citations was conducted using the National Library of Medicine (PubMed) search engine."
Reasoning: PubMed is mentioned as the information source searched but the dates of coverage and last search date are not provided.
[No]
P8
Reasoning: The full electronic search strategy is not presented.
[No]
P9
Reasoning: The process for selecting studies is not described.
[No]
P10
Quote: "Demographic information, including patient age, gender, presenting symptoms, number of URS procedures performed and stone-free rate, were abstracted from the papers reviewed. The data are presented in Table 1."
Reasoning: The method of data extraction is described (abstracted from papers) but it is not mentioned if this was done in duplicate.
[No]
P11
Reasoning: The variables for which data were sought are not defined.
[No]
P12
Reasoning: The methods for assessing risk of bias in individual studies are not described.
[No]
P13
Reasoning: Not applicable as this is a systematic review without a meta-analysis.
[NA]
P14
Reasoning: Not applicable as this is a systematic review without a meta-analysis.
[NA]
P15
Reasoning: Not applicable as this is a systematic review without a meta-analysis.
[NA]
P16
Reasoning: Not applicable as this is a systematic review without a meta-analysis.
[NA]
P17
Reasoning: A flow diagram of study selection is not provided and reasons for exclusions at each stage are not given.
[No]
P18
Quote: See Table 1 on page 3 which presents the characteristics of included studies.
Reasoning: For each included study, key characteristics and citations are provided.
[Yes]
P19
Reasoning: Risk of bias assessments of individual studies are not reported.
[No]
P20
Reasoning: Results of individual studies are not presented. Only aggregate results across studies are provided.
[No]
P21
Reasoning: Not applicable as this is a systematic review without a meta-analysis.
[NA]
P22
Reasoning: Not applicable as this is a systematic review without a meta-analysis.
[NA]
P23
Reasoning: Not applicable as this is a systematic review without a meta-analysis.
[NA]
P24
Quote: "URS is safe and efficacious in the management of pediatric urolithiasis. URS should be considered an essential part of the armamentarium of any urologist involved in the care of children and is now considered the standard of care for the management of pediatric urolithiasis."
Reasoning: The main findings are summarized.
[Yes]
P25
Reasoning: Limitations at the study, outcome, and review level are not discussed.
[No]
P26
Quote: "A thorough knowledge of available equipment and the anatomical and physiological differences of pediatric patients will ensure a successful outcome with minimal morbidity to these patients."
Reasoning: A general interpretation of the results is provided along with implications for practice.
[Yes]
P27
Reasoning: Sources of funding for the systematic review are not described.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
0
|
0
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
0
|
0
|
0
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
1
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
1
|
NA
|
0
|
1
|
0
|
1
|
1
|
0
|
NA
|
1
|
1
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
NA
|
NA
|
0
|
1
|
0
|
0
|
1
|
NA
|
NA
|
1
|
1
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
1
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
0
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
0
|
1
|
0
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
LLM response
21 quote(s) from
publication full text (mean similarity 99%)
A1. Was an 'a priori' design provided?
Quotes: None relevant.
Reasoning: No mention of a protocol, ethics approval, or a priori objectives.
[No]
A2. Was there duplicate study selection and data extraction?
Quotes: "Two authors (RR and AN) independently extracted data from the retrieved articles."
Reasoning: Two authors independently extracted data, but no mention of duplicate study selection.
[No]
A3. Was a comprehensive literature search performed?
Quotes: "All publications describing both absorbable (SIS) and nonabsorbable (PTFE) materials for CDH repair were sought from the Cochrane Trials Register and the Cochrane Central Register of Controlled Trials (CENTRAL) database. All studies were identified through electronic searches of MEDLINE (1966 onwards), EMBASE (1980 onwards), and CINAHL (1982 onwards) and from hand-searching journals and conference proceedings."
Reasoning: Multiple databases and other sources were searched.
[Yes]
A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion?
Quotes: None relevant.
Reasoning: No mention of including grey literature or unpublished studies.
[No]
A5. Was a list of studies (included and excluded) provided?
Quotes: None relevant.
Reasoning: No list of included or excluded studies provided.
[No]
A6. Were the characteristics of the included studies provided?
Quotes: "Institutional demographic and clinical severity data" (Table 1)
"Outcomes after CDH patch repair—institutional data" (Table 2)
Reasoning: Characteristics of included studies provided in tables.
[Yes]
A7. Was the scientific quality of the included studies assessed and documented?
Quotes: "Three authors (RR, AN, and JL) independently assessed all published articles and identified as potentially relevant by the literature search for inclusion in the review. Quality criteria used for study inclusion included (1) appropriate selection of comparison/control group; (2) control of factors such as selection bias, observation bias, and confounders; (3) completeness of follow-up; and (4) accurate outcome measurement."
Reasoning: Quality criteria were defined and applied to included studies.
[Yes]
A8. Was the scientific quality of the included studies used appropriately in formulating conclusions?
Quotes: None relevant.
Reasoning: No discussion of study quality when formulating conclusions.
[No]
A9. Were the methods used to combine the findings of studies appropriate?
Quotes: "Meta-analysis was performed combining our data with the published literature examining the effect of patch type on recurrence and small bowel obstruction (SBO)."
Reasoning: Meta-analysis was performed to combine study findings.
[Yes]
A10. Was the likelihood of publication bias assessed?
Quotes: None relevant.
Reasoning: Publication bias not assessed.
[No]
A11. Was the conflict of interest included?
Quotes: "* Corresponding author. Robert M. Filler Chair and Chief, General and Thoracic Surgery, Hospital for Sick Children, Toronto ON M5G 1X8. Tel.: +1 416 813 7340; fax: +1 416 813 7477. E-mail address: jacob.langer@sickkids.ca (J.C. Langer)."
Reasoning: Affiliations and contact information provided for corresponding author, but no explicit COI statement for review authors or included studies.
[No]
P1. Title: Identify the report as a systematic review, meta-analysis, or both.
Quote: "What is the best prosthetic material for patch repair of congenital diaphragmatic hernia? Comparison and meta-analysis of porcine small intestinal submucosa and polytetrafluoroethylene"
Reasoning: Title identifies the report as a comparison and meta-analysis.
[Yes]
P2. Abstract / Structured summary
Quote: The abstract contains labeled Background, Methods, Results, and Conclusions sections.
Reasoning: The abstract is structured with distinct labeled sections.
[Yes]
P3. Introduction / Rationale
Quote: "Congenital diaphragmatic hernia is a rare condition. The need for patch repair occurs in less than one third of cases in most series. Issues with sample size are common in studies dealing with rare diseases in pediatric surgery."
Reasoning: Provides rationale for the review in the context of what is known about CDH.
[Yes]
P4. Introduction / Objectives
Quote: "The comparison could be to another group, whether it was part of a controlled trial, a case-control study, or a cohort study."
Reasoning: Objectives are stated but do not explicitly reference PICOS.
[No]
P5. Methods / Protocol and registration
Quotes: None relevant.
Reasoning: No mention of a protocol or registration.
[No]
P6. Methods / Eligibility criteria
Quote: "The comparison could be to another group, whether it was part of a controlled trial, a case-control study, or a cohort study."
Reasoning: Some eligibility criteria are provided but not a complete rationale.
[No]
P7. Methods / Information sources
Quote: "All publications describing both absorbable (SIS) and nonabsorbable (PTFE) materials for CDH repair were sought from the Cochrane Trials Register and the Cochrane Central Register of Controlled Trials (CENTRAL) database. All studies were identified through electronic searches of MEDLINE (1966 onwards), EMBASE (1980 onwards), and CINAHL (1982 onwards) and from hand-searching journals and conference proceedings."
Reasoning: Databases and other information sources are described.
[Yes]
P8. Methods / Search
Quotes: None relevant.
Reasoning: Full search strategies are not presented.
[No]
P9. Methods / Study selection
Quote: "The following data were extracted from all the studies that were present, and attention was drawn to dissecting healthy muscular tissue for a primary repair. If, following dissection of both the anterior and posterior rim of the diaphragm, the defect was deemed too large, the decision for diaphragmatic replacement (flap or patch) and the choice of material was made based upon surgeon's preference."
Reasoning: The study selection process is described.
[Yes]
P10. Methods / Data collection process
Quote: "Two authors (RR and AN) independently extracted data from the retrieved articles."
Reasoning: Data extraction was done independently by two authors.
[Yes]
P11. Methods / Data items
Quotes: None relevant.
Reasoning: Variables for which data were sought are not defined.
[No]
P12. Methods / Risk of bias in individual studies
Quote: "Three authors (RR, AN, and JL) independently assessed all published articles and identified as potentially relevant by the literature search for inclusion in the review. Quality criteria used for study inclusion included (1) appropriate selection of comparison/control group; (2) control of factors such as selection bias, observation bias, and confounders; (3) completeness of follow-up; and (4) accurate outcome measurement."
Reasoning: Risk of bias was assessed using defined criteria.
[Yes]
P13. Methods / Summary measures
Quotes: None relevant.
Reasoning: Principal summary measures are not stated.
[No]
P14. Methods / Synthesis of results
Quote: "Meta-analysis was performed combining our data with the published literature examining the effect of patch type on recurrence and small bowel obstruction (SBO)."
Reasoning: Meta-analysis was used to synthesize results.
[Yes]
P15. Methods / Risk of bias across studies
Quotes: None relevant.
Reasoning: Assessment of risk of bias across studies is not mentioned.
[NA] - Not applicable for a systematic review without meta-analysis.
P16. Methods / Additional analyses
Quotes: None relevant.
Reasoning: No additional analyses mentioned.
[NA] - Not applicable for a systematic review without meta-analysis.
P17. Results / Study selection
Quotes: None relevant.
Reasoning: Numbers of studies screened, assessed for eligibility, and included are not fully reported with a flow diagram.
[No]
P18. Results / Study characteristics
Quote: "Institutional demographic and clinical severity data" (Table 1)
"Outcomes after CDH patch repair—institutional data" (Table 2)
Reasoning: Study characteristics are reported in tables.
[Yes]
P19. Results / Risk of bias within studies
Quotes: None relevant.
Reasoning: Results of the risk of bias assessment for individual studies are not presented.
[No]
P20. Results / Results of individual studies
Quote: "Outcomes after CDH patch repair—institutional data" (Table 2)
Reasoning: Table 2 presents outcome data for each group, but no effect estimates or confidence intervals.
[No]
P21. Results / Synthesis of results
Quote: "Meta-analysis was performed combining our data with the published literature examining the effect of patch type on recurrence and small bowel obstruction (SBO)." (Figs. 1 and 2)
Reasoning: Meta-analysis results are presented with forest plots.
[Yes]
P22. Results / Risk of bias across studies
Quotes: None relevant.
Reasoning: No presentation of risk of bias assessment across studies.
[NA] - Not applicable for a systematic review without meta-analysis.
P23. Results / Additional analysis
Quotes: None relevant.
Reasoning: No additional analyses reported.
[NA] - Not applicable for a systematic review without meta-analysis.
P24. Discussion / Summary of evidence
Quote: "Larger defects of the diaphragm in patients with CDH have been associated with more severe clinical manifestations and pulmonary hypoplasia and pulmonary hypertension [1]. In the past, many children with large defects died, but over the past decades, as medical management has improved, the number of patients surviving to repair has increased."
Reasoning: Key findings are summarized.
[Yes]
P25. Discussion / Limitations
Quote: "Retrospective chart studies are particularly susceptible to bias, especially patient selection. For example, numbers of exclusions are frequently unclear, intervention and outcome assessment are often not conducted according to standardized protocols, and outcomes may not be assessed blind."
Reasoning: Some limitations at the study and review level are discussed.
[Yes]
P26. Discussion / Conclusions
Quote: "It is possible that development of new absorbable materials, which become replaced with scar tissue more quickly, or further development of composite patches will improve the recurrence risk for patch repair of CDH."
Reasoning: General interpretation and implications for future research are provided.
[Yes]
P27. Funding
Quote: "* Corresponding author. Robert M. Filler Chair and Chief, General and Thoracic Surgery, Hospital for Sick Children, Toronto ON M5G 1X8. Tel.: +1 416 813 7340; fax: +1 416 813 7477. E-mail address: jacob.langer@sickkids.ca (J.C. Langer)."
Reasoning: Source of funding for the systematic review is not described.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
0
|
0
|
1
|
0
|
0
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
0
|
0
|
0
|
0
|
0
|
1
|
0
|
0
|
0
|
0
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
0
|
NA
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
1
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
NA
|
NA
|
0
|
1
|
0
|
0
|
NA
|
NA
|
NA
|
1
|
0
|
0
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
1
|
0
|
1
|
0
|
1
|
0
|
0
|
1
|
0
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
0
|
0
|
0
|
0
|
1
|
0
|
NA
|
NA
|
NA
|
0
|
LLM response
15 quote(s) from
publication full text (mean similarity 100%)
A1
Quote: "This systematic review reveals that TERPT is a safe and less-invasive procedure with a low incidence of postoperative HAEC."
Reasoning: The research question and inclusion criteria are not explicitly stated to have been established a priori.
[No]
A2
No relevant quotes found.
Reasoning: There is no mention of duplicate study selection and data extraction.
[No]
A3
Quotes: "PubMed and Medline were searched for all studies that reported cases of patients who had undergone surgical correction of HD on transanal one-stage pull-through operation between 1998 and 2009. The search terms were "one-stage transanal pull-through", "transanal one-stage endorectal pull-through", "one-stage Soave pull-through", "single-stage transanal endorectal pull-through", "primary pull-through", or "Soave procedure"."
Reasoning: At least two databases were searched with the key terms provided, but no supplementary search strategies are mentioned.
[No]
A4
No relevant quotes found.
Reasoning: The inclusion of grey literature is not mentioned.
[No]
A5
Quote: "Out of these 54 articles, 27 articles, identified as reporting entirely TERPT without additional laparotomy, laparoscopy or preoperative colostomy, formed the basis of our study (Table 1)."
Reasoning: A list of included studies is provided in Table 1, but a list of excluded studies is not provided.
[No]
A6
Quote: "There were a total of 899 patients. Information about patient's gender was reported in 760 (84.5%) patients. 563 (74.1%) patients were male and 197 (25.9%) patients were female. A male-to-female ratio of 2.8:1 was observed. Patient's age at the time of operation was reported in 811 (90.2%) patients (median 9.2 months, range 6 days to 14 years)."
Reasoning: Aggregated data on the characteristics of included studies is provided.
[Yes]
A7
Quote: "Despite many studies, the pathogenesis of HAEC is not fully understood. Various hypotheses regarding the etiology have been postulated. These include partial mechanical obstruction by the remaining aganglionic segment, spastic internal sphincter, and qualitative changes in the intestinal mucin [16, 22–26]. Increased risk of HAEC due to the presence of an anastomotic leak and postoperative stricture has been well documented [19, 27, 28]."
Reasoning: The scientific quality of included studies was not assessed.
[No]
A8
[NA]
A9
[NA]
A10
[NA]
A11
No relevant quotes found.
Reasoning: Conflicts of interest are not reported for the systematic review or the included studies.
[No]
P1
Quote: "Systematic review and meta-analysis of enterocolitis after one-stage transanal pull-through procedure for Hirschsprung's disease"
Reasoning: The title identifies the article as a systematic review and meta-analysis.
[Yes]
P2
Quote: "Abstract Purpose The transanal one-stage pull-through procedure (TERPT) has gained worldwide popularity over open and laparoscopic-assisted one-stage techniques in children with Hirschsprung's disease (HD). It offers the advantages of avoiding laparotomy, laparoscopy, scars, abdominal contamination, and adhesions. However, enterocolitis associated with Hirschsprung's disease (HAEC) still remains to be a potentially life-threatening complication after pullthrough operation. The reported incidence of HAEC ranges from 4.6 to 54%. This meta-analysis was designed to evaluate postoperative incidence of HAEC following TERPT procedure."
Reasoning: The abstract provides a structured summary including background, purpose, methods, results and conclusions.
[Yes]
P3
Quote: "Hirschsprung's disease (HD) is the most common cause of intestinal obstruction in children [1]. Since the introduction of operative treatment of HD by Swenson [2], various operative procedures gradually evolved during the decades. Multistage surgery has progressed to open or laparoscopic-assisted one-stage repair. Transanal one-stage pull-through procedure (TERPT) represents the latest development in the concept of the minimal invasive surgery for HD [3–11]. TERPT was introduced in the late 1990s by De la Torre and Ortega and has rapidly replaced traditional procedures for the management of rectosigmoid HD in many pediatric surgical centers around the world [3, 4].When compared with the traditional open laparotomy, the advantages of the TERPT are that it is a minimally invasive procedure with a short hospital stay. It eliminates abdominal incision and avoids complications of traditional laparotomy, such as intestinal adhesion, damage to pelvic structures, and wound infection postoperatively."
Reasoning: The introduction describes the rationale for the review in the context of what is already known about Hirschsprung's disease and its surgical treatment.
[Yes]
P4
Quote: "This meta-analysis was designed to evaluate postoperative incidence of HAEC following TERPT procedure."
Reasoning: The objective is stated but does not explicitly reference the PICOS.
[No]
P5
No relevant quotes found.
Reasoning: The existence of a review protocol is not mentioned.
[No]
P6
No relevant quotes found.
Reasoning: The study characteristics and report characteristics used as eligibility criteria are not specified.
[No]
P7
Quote: "PubMed and Medline were searched for all studies that reported cases of patients who had undergone surgical correction of HD on transanal one-stage pull-through operation between 1998 and 2009."
Reasoning: The information sources are described but the date last searched is not provided.
[No]
P8
Quote: "The search terms were "one-stage transanal pull-through", "transanal one-stage endorectal pull-through", "one-stage Soave pull-through", "single-stage transanal endorectal pull-through", "primary pull-through", or "Soave procedure"."
Reasoning: The search terms are provided but the full search strategy for at least one database is not presented.
[No]
P9
Quote: "Out of these 54 articles, 27 articles, identified as reporting entirely TERPT without additional laparotomy, laparoscopy or preoperative colostomy, formed the basis of our study (Table 1)."
Reasoning: The process of study selection is briefly described.
[Yes]
P10
No relevant quotes found.
Reasoning: The method of data extraction is not described.
[No]
P11
No relevant quotes found.
Reasoning: The variables for which data were sought are not defined.
[No]
P12
No relevant quotes found.
Reasoning: The methods for assessing risk of bias in individual studies are not described.
[No]
P13
No relevant quotes found.
Reasoning: The principal summary measures are not stated.
[No]
P14
[NA]
P15
[NA]
P16
[NA]
P17
Quote: "Out of these 54 articles, 27 articles, identified as reporting entirely TERPT without additional laparotomy, laparoscopy or preoperative colostomy, formed the basis of our study (Table 1)."
Reasoning: The number of studies included is provided but a flow diagram with the number screened and assessed for eligibility at each stage is not included.
[No]
P18
Quote: See Table 1
Reasoning: Table 1 presents the characteristics of each included study along with citations.
[Yes]
P19
No relevant quotes found.
Reasoning: Data on the risk of bias for each included study is not presented.
[No]
P20
No relevant quotes found.
Reasoning: Simple summary data and effect estimates for each study are not provided.
[No]
P21
[NA]
P22
[NA]
P23
[NA]
P24
Quote: "This systematic review reveals that the incidence of postoperative and recurrent HAEC after TERPT procedure is remarkably lower than incidence rates of HAEC reported after other procedures, confirming TERPT as a safe operation with a low incidence of postoperative HAEC. The mainstay of management of postoperative HAEC still remains to be intensive supportive care. Preventive measures and better treatment modalities will evolve out of a better understanding of the underlying pathophysiology. Prompt recognition of HAEC allows in early intervention and a potential reduction in disease severity and mortality."
Reasoning: The main findings are summarized.
[Yes]
P25
Quote: "Despite many studies, the pathogenesis of HAEC is not fully understood. Various hypotheses regarding the etiology have been postulated."
Reasoning: Limitations at the study level are briefly mentioned, but limitations at the review level are not discussed.
[No]
P26
Quote: "Prompt recognition of HAEC allows in early intervention and a potential reduction in disease severity and mortality."
Reasoning: A general interpretation is provided but implications for future research are not clearly stated.
[No]
P27
No relevant quotes found.
Reasoning: Sources of funding for the systematic review are not described.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
1
|
1
|
0
|
0
|
0
|
NA
|
NA
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
NA
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
1
|
1
|
0
|
NA
|
NA
|
NA
|
NA
|
1
|
0
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
NA
|
NA
|
0
|
0
|
0
|
0
|
NA
|
NA
|
NA
|
1
|
0
|
0
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
NA
|
NA
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
NA
|
NA
|
NA
|
0
|
LLM response
15 quote(s) from
publication full text (mean similarity 99.7%)
A1
Quote: "This systematic review reveals that TERPT is a safe and less-invasive procedure with a low incidence of postoperative HAEC."
Reasoning: The research question and inclusion criteria are not explicitly stated to have been established a priori.
Response: [No]
A2
Quotes: N/A
Reasoning: There is no mention of duplicate study selection and data extraction.
Response: [No]
A3
Quote: "PubMed and Medline were searched for all studies that reported cases of patients who had undergone surgical correction of HD on transanal one-stage pull-through operation between 1998 and 2009. The search terms were "one-stage transanal pull-through", "transanal one-stage endorectal pull-through", "one-stage Soave pull-through", "single-stage transanal endorectal pull-through", "primary pull-through", or "Soave procedure". The reference list from retrieved articles was reviewed for additional cases."
Reasoning: At least two databases were searched and key terms were provided, but there is no mention of supplementary strategies.
Response: [No]
A4
Quotes: N/A
Reasoning: There is no mention of including grey literature as an inclusion criterion.
Response: [No]
A5
Quotes: N/A
Reasoning: A list of included and excluded studies is not provided.
Response: [No]
A6
Quote: "Detailed information was recorded regarding intraoperative details and postoperative complications with particular emphasis on incidence of HAEC."
Reasoning: Some characteristics of included studies were provided in aggregate form but not comprehensively.
Response: [No]
A7
Quotes: N/A
Reasoning: There is no mention of assessing the scientific quality of included studies.
Response: [No]
A8
Quotes: N/A
Reasoning: Not applicable as the scientific quality of included studies was not assessed (A7).
Response: [NA]
A9
Quotes: N/A
Reasoning: Not applicable as this is a systematic review without a meta-analysis.
Response: [NA]
A10
Quotes: N/A
Reasoning: Not applicable as this is a systematic review without a meta-analysis.
Response: [NA]
A11
Quotes: N/A
Reasoning: Sources of support are not acknowledged for the systematic review or included studies.
Response: [No]
P1
Quote: "Systematic review and meta-analysis of enterocolitis after one-stage transanal pull-through procedure for Hirschsprung's disease"
Reasoning: The title identifies the report as a systematic review and meta-analysis.
Response: [Yes]
P2
Quote: "Abstract Purpose The transanal one-stage pull-through procedure (TERPT) has gained worldwide popularity over open and laparoscopic-assisted one-stage techniques in children with Hirschsprung's disease (HD). It offers the advantages of avoiding laparotomy, laparoscopy, scars, abdominal contamination, and adhesions. However, enterocolitis associated with Hirschsprung's disease (HAEC) still remains to be a potentially life-threatening complication after pullthrough operation. The reported incidence of HAEC ranges from 4.6 to 54%. This meta-analysis was designed to evaluate postoperative incidence of HAEC following TERPT procedure."
Reasoning: The abstract provides a structured summary with labeled sections for background, purpose, methods, results, and conclusions.
Response: [Yes]
P3
Quote: "Hirschsprung's disease (HD) is the most common cause of intestinal obstruction in children [1]. Since the introduction of operative treatment of HD by Swenson [2], various operative procedures gradually evolved during the decades. Multistage surgery has progressed to open or laparoscopic-assisted one-stage repair. Transanal one-stage pull-through procedure (TERPT) represents the latest development in the concept of the minimal invasive surgery for HD [3–11]. TERPT was introduced in the late 1990s by De la Torre and Ortega and has rapidly replaced traditional procedures for the management of rectosigmoid HD in many pediatric surgical centers around the world [3, 4].When compared with the traditional open laparotomy, the advantages of the TERPT are that it is a minimally invasive procedure with a short hospital stay. It eliminates abdominal incision and avoids complications of traditional laparotomy, such as intestinal adhesion, damage to pelvic structures, and wound infection postoperatively."
Reasoning: The introduction describes the rationale for the review in the context of what is already known about Hirschsprung's disease and its surgical treatment.
Response: [Yes]
P4
Quote: "This meta-analysis was designed to evaluate postoperative incidence of HAEC following TERPT procedure."
Reasoning: The introduction provides an explicit statement of the question being addressed, but does not reference all PICOS elements.
Response: [No]
P5
Quotes: N/A
Reasoning: There is no mention of a review protocol or registration.
Response: [No]
P6
Quotes: N/A
Reasoning: Eligibility criteria are not clearly specified.
Response: [No]
P7
Quote: "PubMed and Medline were searched for all studies that reported cases of patients who had undergone surgical correction of HD on transanal one-stage pull-through operation between 1998 and 2009."
Reasoning: Information sources are described but the date last searched is not provided.
Response: [No]
P8
Quotes: N/A
Reasoning: The full search strategy is not presented for any database.
Response: [No]
P9
Quotes: N/A
Reasoning: The study selection process is not described.
Response: [No]
P10
Quotes: N/A
Reasoning: The data collection process is not described.
Response: [No]
P11
Quote: "Detailed information was recorded regarding the type of study, patient's age and gender, intraoperative details, and postoperative complications with particular emphasis on the incidence and outcome of HAEC. The diagnosis of HAEC in a HD patient was based on the clinical presentation of diarrhoea, abdominal distension, and fever."
Reasoning: Some data items are listed but not comprehensively.
Response: [No]
P12
Quotes: N/A
Reasoning: Methods for assessing risk of bias in individual studies are not described.
Response: [No]
P13
Quotes: N/A
Reasoning: Not applicable as this is a systematic review without a meta-analysis.
Response: [NA]
P14
Quotes: N/A
Reasoning: Not applicable as this is a systematic review without a meta-analysis.
Response: [NA]
P15
Quotes: N/A
Reasoning: Not applicable as this is a systematic review without a meta-analysis.
Response: [NA]
P16
Quotes: N/A
Reasoning: Not applicable as this is a systematic review without a meta-analysis.
Response: [NA]
P17
Quote: "During the period between 1998 and 2009, 54 published articles reporting TERPT procedures for HD were identified in the world literature. Out of these 54 articles, 27 articles, identified as reporting entirely TERPT without additional laparotomy, laparoscopy or preoperative colostomy, formed the basis of our study (Table 1)."
Reasoning: The number of studies screened, assessed for eligibility, and included are provided, but reasons for exclusions at each stage are not given and there is no flow diagram.
Response: [No]
P18
Quote: "There were a total of 899 patients. Information about patient's gender was reported in 760 (84.5%) patients. 563 (74.1%) patients were male and 197 (25.9%) patients were female. A male-to-female ratio of 2.8:1 was observed. Patient's age at the time of operation was reported in 811 (90.2%) patients (median 9.2 months, range 6 days to 14 years)."
Reasoning: Some characteristics of included studies are presented but not comprehensively and citations are not provided.
Response: [No]
P19
Quotes: N/A
Reasoning: Risk of bias assessments for individual studies are not presented.
Response: [No]
P20
Quotes: N/A
Reasoning: Results for individual studies are not presented.
Response: [No]
P21
Quotes: N/A
Reasoning: Not applicable as this is a systematic review without a meta-analysis.
Response: [NA]
P22
Quotes: N/A
Reasoning: Not applicable as this is a systematic review without a meta-analysis.
Response: [NA]
P23
Quotes: N/A
Reasoning: Not applicable as this is a systematic review without a meta-analysis.
Response: [NA]
P24
Quote: "The reported incidence of post pull-through HAEC ranges from 4.6 to 54% in various series, which may be partially due to the use of different diagnostic criteria [16–19]. Carneiro et al. report a lower incidence after Duhamel procedure, and Kleinhaus, Ikeda and Moore report a significantly higher incidence of HAEC after Swenson's procedure [1, 18, 34, 35]. However, the majority of recent reports found the incidence of HAEC to be unrelated to type and timing of definitive surgery [15, 19, 30, 34, 36]. In the present review, postoperative HAEC occurred in 92 patients, which lead to an incidence rate of HAEC of 10.2%. The incidence of recurrent HAEC varies from 5.2 to 56% in various reported series [15, 16, 34]. Frequency of bouts of HAEC is supposed to decrease with time [37]. In our present review the rate of recurrent episodes of HAEC was 2%. As compared to the incidence rates reported in the literature, the incidence of postoperative and recurrent HAEC following the TERPT procedure was remarkably lower in this review."
Reasoning: The main findings are summarized, including the strength of evidence and relevance to key groups.
Response: [Yes]
P25
Quote: "Prompt diagnosis, rectal washouts, and stoma formation are crucial factors in the prevention of severe morbidity associated with HAEC."
Reasoning: Limitations at the study, outcome, and review level are not adequately discussed.
Response: [No]
P26
Quote: "Considering the fact that the preoperative and postoperative management of HD has been similar over the last decade, it is reasonable to consider the TERPT procedure as a contributor to the observed low rate of postoperative HAEC."
Reasoning: A general interpretation is provided in the context of other evidence, but implications for future research are not clearly stated.
Response: [No]
P27
Quotes: N/A
Reasoning: Sources of funding for the systematic review are not described.
Response: [No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
0
|
1
|
0
|
NA
|
NA
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
1
|
0
|
0
|
0
|
0
|
0
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
1
|
0
|
0
|
NA
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
NA
|
NA
|
0
|
1
|
0
|
0
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
0
|
0
|
0
|
1
|
1
|
1
|
NA
|
NA
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
0
|
0
|
0
|
0
|
1
|
0
|
0
|
NA
|
NA
|
0
|
LLM response
19 quote(s) from
publication full text (mean similarity 97.4%)
AMSTAR Checklist:
A1. Was an 'a priori' design provided?
Quote: "We performed an electronic search in PubMed up to March 2012 with the terms "single AND incision OR site OR port OR trocar AND children" including related articles and obtained 197 articles."
Reasoning: The authors specified their search terms and inclusion criteria a priori.
[Yes]
A2. Was there duplicate study selection and data extraction?
Quote: Not mentioned
Reasoning: The authors did not report any information about duplicate study selection or data extraction.
[No]
A3. Was a comprehensive literature search performed?
Quote: "We performed an electronic search in PubMed up to March 2012 with the terms "single AND incision OR site OR port OR trocar AND children" including related articles and obtained 197 articles."
Reasoning: Only one database (PubMed) was searched, which does not constitute a comprehensive search.
[No]
A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion?
Quote: Not mentioned
Reasoning: The authors did not report whether they included or excluded studies based on publication status.
[No]
A5. Was a list of studies (included and excluded) provided?
Quote: "After applying our inclusion criteria, we reviewed 78 articles."
Reasoning: A list of included studies was not provided, and excluded studies were not mentioned at all.
[No]
A6. Were the characteristics of the included studies provided?
Quote: "Table 1. Single-Incision Pediatric Endosurgery Procedures by Systems"
Reasoning: The characteristics of included studies were provided in aggregate form in Table 1.
[Yes]
A7. Was the scientific quality of the included studies assessed and documented?
Quote: Not mentioned
Reasoning: The authors did not report assessing or documenting the quality of included studies.
[No]
A8. Was the scientific quality of the included studies used appropriately in formulating conclusions?
Quote: Not mentioned
Reasoning: Since study quality was not assessed, it could not be used to inform the conclusions.
[No]
A9. Were the methods used to combine the findings of studies appropriate?
Quote: Not applicable
Reasoning: This was a systematic review without a meta-analysis, so there was no combining of study findings.
[NA]
A10. Was the likelihood of publication bias assessed?
Quote: Not applicable
Reasoning: This was a systematic review without a meta-analysis, so assessment of publication bias is not relevant.
[NA]
A11. Was the conflict of interest included?
Quote: "No competing financial interests exist."
Reasoning: A conflict of interest statement was provided for the systematic review, but not for the individual included studies.
[No]
PRISMA Checklist:
P1. Title
Quote: "Single-Incision Pediatric Endosurgery: A Systematic Review"
Reasoning: The title identifies the article as a systematic review.
[Yes]
P2. Abstract / Structured summary
Quote: The abstract is structured with labeled sections for Background, Materials and Methods, Results, and Conclusions.
Reasoning: A structured abstract with the required sections is provided.
[Yes]
P3. Introduction / Rationale
Quote: "Single-incision endosurgery (SIES) is defined as minimally invasive surgery performed through a unique incision in the abdomen, chest, or retroperitoneum."
Reasoning: The rationale for the review is described in the context of what is known about SIES.
[Yes]
P4. Introduction / Objectives
Quote: "The objective of this review is to show the initial published experience about SIPES to evaluate its real benefits in terms of feasibility and clinical outcomes."
Reasoning: An explicit objective statement is provided.
[Yes]
P5. Methods / Protocol and registration
Quote: Not mentioned
Reasoning: The authors did not mention a protocol or registration number.
[No]
P6. Methods / Eligibility criteria
Quote: "Articles were considered eligible if they met the following inclusion criteria: (1) Operations were performed through a single incision. (2) The target population was children under 18 years of age. (3) Operations performed exclusively by pediatric surgeons. (4) Series larger than 100 patients were included for appendectomy operations. (5) Case reports, case series, and comparative and prospective randomized trials were included in other, nonappendectomy, operations because of their low incidence."
Reasoning: The eligibility criteria for included studies are clearly specified.
[Yes]
P7. Methods / Information sources
Quote: "We performed an electronic search in PubMed up to March 2012"
Reasoning: PubMed is stated as the only information source searched.
[Yes]
P8. Methods / Search
Quote: "We performed an electronic search in PubMed up to March 2012 with the terms "single AND incision OR site OR port OR trocar AND children" including related articles and obtained 197 articles."
Reasoning: The full search strategy for PubMed is provided.
[Yes]
P9. Methods / Study selection
Quote: "After applying our inclusion criteria, we reviewed 78 articles."
Reasoning: The number of studies reviewed after applying inclusion criteria is stated, but the full study selection process is not described.
[No]
P10. Methods / Data collection process
Quote: Not mentioned
Reasoning: The data collection process is not described.
[No]
P11. Methods / Data items
Quote: Not mentioned
Reasoning: Data items sought are not defined.
[No]
P12. Methods / Risk of bias in individual studies
Quote: Not mentioned
Reasoning: Assessment of risk of bias in individual studies is not described.
[No]
P13. Methods / Summary measures
Quote: Not mentioned
Reasoning: The principal summary measures are not stated.
[No]
P14. Methods / Synthesis of results
Quote: Not applicable
Reasoning: This was a systematic review without a meta-analysis.
[NA]
P15. Methods / Risk of bias across studies
Quote: Not applicable
Reasoning: This was a systematic review without a meta-analysis.
[NA]
P16. Methods / Additional analyses
Quote: Not applicable
Reasoning: This was a systematic review without a meta-analysis.
[NA]
P17. Results / Study selection
Quote: "After applying our inclusion criteria, we reviewed 78 articles."
Reasoning: The number of studies reviewed is provided, but a full study selection flow diagram is not included.
[No]
P18. Results / Study characteristics
Quote: "Table 1. Single-Incision Pediatric Endosurgery Procedures by Systems"
Reasoning: Study characteristics are presented in aggregate in Table 1.
[Yes]
P19. Results / Risk of bias within studies
Quote: Not mentioned
Reasoning: Risk of bias assessments for individual studies are not reported.
[No]
P20. Results / Results of individual studies
Quote: Not mentioned
Reasoning: Results for individual studies are not provided.
[No]
P21. Results / Synthesis of results
Quote: Not applicable
Reasoning: This was a systematic review without a meta-analysis.
[NA]
P22. Results / Risk of bias across studies
Quote: Not applicable
Reasoning: This was a systematic review without a meta-analysis.
[NA]
P23. Results / Additional analysis
Quote: Not applicable
Reasoning: This was a systematic review without a meta-analysis.
[NA]
P24. Discussion / Summary of evidence
Quote: "In summary, we have made a systematic search of all the SIPES procedures reported in the literature, under our inclusion criteria, finding no objective evidence in clinical outcomes, except for appendectomies."
Reasoning: The main findings are summarized, considering their relevance to key groups.
[Yes]
P25. Discussion / Limitations
Quote: "The low incidence of most of the procedures (favoring case series with low level of evidence) and the lack of uniformity in evaluating some measures among surgeons, like pain assessment or cosmesis, for example, are the main contributors to this limitation."
Reasoning: Limitations at the study and review level are discussed.
[Yes]
P26. Discussion / Conclusions
Quote: "A wide experience in SIPES and its feasibility have already been described with good clinical outcomes and low rate of conversion. Appendectomy is the unique procedure in which SIPES has demonstrated to be safe and effective. The majority of SIPES procedures were performed in the "children" and "adolescents" groups. Cosmesis seems to be a self-evident benefit of SIPES, although there is no objective assessment of it among authors in the literature, and it must be carefully weighed against the possibility of affecting the safety of the procedure."
Reasoning: The conclusions provide a general interpretation of the results in the context of other evidence and implications for future research.
[Yes]
P27. Funding
Quote: "No competing financial interests exist."
Reasoning: Sources of funding for the systematic review are described, but not for the individual studies.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
NA
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
0
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
NA
|
NA
|
0
|
1
|
1
|
0
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
1
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
NA
|
1
|
LLM response
25 quote(s) from
publication full text (mean similarity 98.5%)
Here is the assessment of the systematic review using AMSTAR and PRISMA:
A1. Was an 'a priori' design provided?
Quote: "Protocol first published: Issue 3, 1999"
Reasoning: The review mentions that a protocol was published before the review.
[Yes]
A2. Was there duplicate study selection and data extraction?
Quote: "Two reviewers independently assessed trial quality. Missing information or data was requested from the authors. We used odds ratios (OR), relative risks (RR), and 95% confidence intervals (CI) for analysis."
Reasoning: Study selection and data extraction were done independently by two reviewers.
[Yes]
A3. Was a comprehensive literature search performed?
Quotes: "We searched the Cochrane Library, MEDLINE (PubMed), EMBASE, SciSearch and Biosis. Additionally, we scanned foreign language databases, such as LILACS (Literatura Latinoamericana y del Caribe en Ciencias de la Salud) and CNKI (Chinese National Knowledge Infrastructure). Some studies were handsearched. The reference lists of all relevant primary studies and review article were screened for further studies (MEDLINE 1997; Golub 1998; Slim 1998; Fingerhut 1999; Chung 1999; Garbutt 1999; Barth 1999; Temple 1999; Kim 2004;Aziz 2006; Kapischke 2006; Bennett 2007; Sadr-Azodi 2009). Additionally, the international experts in the field of laparoscopic surgery were contacted to obtain information on any past, present, or future studies."
Reasoning: A comprehensive search was performed using multiple electronic databases and other sources.
[Yes]
A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion?
Quote: "Abstracts presented to the following international scientific societies were handsearched: European Association of Endoscopic Surgery (EAES), Society of American Gastrointestinal Endoscopic Surgeons (SAGES), American Society for Gastrointestinal Endoscopy (ASGE), Asian Surgical Association (ASA), International Society for Surgery (ISS), Endoscopic and Laparoscopic Society of Asia (ELSA), Surgical Infection Society (SIS), and the German Society for Surgery (Deutsche Gesellschaft für Chirurgie, DGCh)."
Reasoning: The authors searched for abstracts from various scientific societies, which can be considered grey literature.
[Yes]
A5. Was a list of studies (included and excluded) provided?
Quote: "Characteristics of excluded studies [ordered by study ID]"
Reasoning: A list of excluded studies with reasons for exclusion is provided.
[Yes]
A6. Were the characteristics of the included studies provided?
Quote: "Characteristics of included studies [ordered by study ID]"
Reasoning: A table with the characteristics of included studies is provided.
[Yes]
A7. Was the scientific quality of the included studies assessed and documented?
Quote: "Risk of bias in included studies" and "Figure 1. Methodological quality summary: review authors' judgements about each methodological quality item for each included study."
Reasoning: The risk of bias (quality) of included studies was assessed and presented in text and a figure.
[Yes]
A8. Was the scientific quality of the included studies used appropriately in formulating conclusions?
Quote: "The diagnostic effects were analysed separately for unselected patients and for women. In both groups, diagnostic laparoscopy was an unnecessary appendectomy and an improved diagnostic efficacy was seen, although the effect was little more pronounced in women."
Reasoning: The authors considered the quality of evidence (unselected patients vs women only) when formulating the conclusions.
[Yes]
A9. Were the methods used to combine the findings of studies appropriate?
[NA] - This review did not perform a meta-analysis.
A10. Was the likelihood of publication bias assessed?
[NA] - This review did not perform a meta-analysis.
A11. Was the conflict of interest included?
Quote: "None."
Reasoning: The review explicitly states there are no conflicts of interest.
[Yes]
P1. Title
Quote: "Laparoscopic versus open surgery for suspected appendicitis"
Reasoning: The title identifies the report as a systematic review comparing laparoscopic vs open surgery.
[Yes]
P2. Abstract / Structured summary
Quote: The abstract is structured with labeled sections for Background, Objectives, Search methods, Selection criteria, Data collection and analysis, Main results, and Authors' conclusions.
Reasoning: The abstract is structured and contains the required elements.
[Yes]
P3. Introduction / Rationale
Quote: "Laparoscopic surgery for acute appendicitis has been proposed to have advantages over conventional surgery."
Reasoning: The introduction describes the rationale for the review in the context of what is known.
[Yes]
P4. Introduction / Objectives
Quote: "To compare the diagnostic and therapeutic effects of laparoscopic and conventional 'open' surgery."
Reasoning: The objectives are explicitly stated.
[Yes]
P5. Methods / Protocol and registration
Quote: "Protocol first published: Issue 3, 1999"
Reasoning: The review indicates that a protocol was published and provides the issue number.
[Yes]
P6. Methods / Eligibility criteria
Quote: "We included randomized clinical trials comparing laparoscopic (LA) versus open appendectomy (OA) in adults or children. Studies comparing immediate OA versus diagnostic laparoscopy (followed by LA or OA if necessary) were separately identified."
Reasoning: The eligibility criteria for study design, participants, and interventions are specified.
[Yes]
P7. Methods / Information sources
Quote: "We searched the Cochrane Library, MEDLINE, EMBASE, LILACS, CNKI, SciSearch, study registries, and the congress proceedings of endoscopic surgical societies."
Reasoning: The information sources searched are described.
[Yes]
P8. Methods / Search
[No] - The full electronic search strategy is not presented.
P9. Methods / Study selection
Quote: "All included studies used similar subjective clinical criteria to identify patients suspected to suffer from acute appendicitis. The age range and the gender ratio, however, were quite different among the studies, since most studies on diagnostic laparoscopy included fertile women only."
Reasoning: The process for selecting studies is described in terms of the clinical criteria used.
[Yes]
P10. Methods / Data collection process
Quote: "Two reviewers independently assessed trial quality. Missing information or data was requested from the authors."
Reasoning: Data extraction was done independently by two reviewers, and study authors were contacted for missing data.
[Yes]
P11. Methods / Data items
Quote: "The therapeutic outcome measures (with their according measurement units) are:
(1) wound infections (rate);
(2) intraabdominal abscesses (rate);
(3) operation time (minutes)
(4) anaesthesia time (minutes)
(5) pain intensity on postoperative day 1 (cm VAS);
(6) length of hospital stay (days);
(7) time until reintroduction of liquid diet (days);
(8) time until reintroduction of solid diet (days);
(9) time until first stool (days);
(10) time until return to normal activities (days);
(11) time until return to full activity (days);
(12) time until return to sport (days);
(13) cosmesis (cm VAS);
(14) costs of the operation;
(15) costs within hospital stay (including the operation); and
(16) costs outside hospital stay."
Reasoning: The data items sought are listed.
[Yes]
P12. Methods / Risk of bias in individual studies
Quote: "The quality of all included studies was moderate to poor (Figure 1). Most studies had very similar flaws. The large number of trials allowed us to exclude the trials without adequate allocation concealment, but still the exact randomizations method of many trials remained unclear."
Reasoning: The methods for assessing risk of bias in individual studies are described.
[Yes]
P13. Methods / Summary measures
[NA] - This review did not perform a meta-analysis.
P14. Methods / Synthesis of results
[NA] - This review did not perform a meta-analysis.
P15. Methods / Risk of bias across studies
[NA] - This review did not perform a meta-analysis.
P16. Methods / Additional analyses
[NA] - This review did not perform a meta-analysis.
P17. Results / Study selection
Quote: "All included studies used similar subjective clinical criteria to identify patients suspected to suffer from acute appendicitis. The age range and the gender ratio, however, were quite different among the studies, since most studies on diagnostic laparoscopy included fertile women only."
Reasoning: The number and characteristics of included studies are described, but a flow diagram is not provided.
[No]
P18. Results / Study characteristics
Quote: "Characteristics of included studies [ordered by study ID]"
Reasoning: A table with the characteristics of included studies is provided.
[Yes]
P19. Results / Risk of bias within studies
Quote: "Risk of bias in included studies" and "Figure 1. Methodological quality summary: review authors' judgements about each methodological quality item for each included study."
Reasoning: The risk of bias assessment for each included study is reported in text and a figure.
[Yes]
P20. Results / Results of individual studies
[No] - The results of individual studies are not presented with summary data and effect estimates for each outcome.
P21. Results / Synthesis of results
[NA] - This review did not perform a meta-analysis.
P22. Results / Risk of bias across studies
[NA] - This review did not perform a meta-analysis.
P23. Results / Additional analysis
[NA] - This review did not perform additional analyses.
P24. Discussion / Summary of evidence
Quote: "Although the overall effects of laparoscopic surgery for suspected appendicitis are impressive, the laparoscopic surgeons involved in these trials were well-trained experts in laparoscopy. Therefore, surgical expertise with laparoscopic techniques is a basic prerequisite before surgeons can justly expect clinical benefits from LA. The still ongoing dissemination of the various laparoscopic techniques, however, renders it likely that the majority of future surgeons will be able to obtain training more easily."
Reasoning: The main findings are summarized, including their relevance to surgeons.
[Yes]
P25. Discussion / Limitations
Quote: "The reduction of the rate of patients without definite diagnosis is difficult to value, since some of these patients are likely to have no serious intraabdominal disease. On the other hand, there will also be cases, in whom conventional appendectomy overlooks a serious, perhaps even malignant disease. Such cases will most likely receive a definite diagnosis within or after hospital stay. However, since most trials focused on early results (Kum 1993; Ortega 1996; Mutter 1996; Pozo 1996; Lejus 1996; Lintula 2004; Huang 2001; Ignacio 2003), did not extend follow-up beyond hospital discharge, these case of recurrent diseases could have been missed in the trials."
Reasoning: Limitations of the review, such as short follow-up periods in most trials, are discussed.
[Yes]
P26. Discussion / Conclusions
Quote: "In summary, laparoscopic surgery for suspected appendicitis has diagnostic and therapeutic advantages as compared to conventional surgery. However, conventional appendectomy should not be considered 'wrong', because the difference between the two techniques is rather small and strongly depends on patient characteristics and the treating surgeon's expertise."
Reasoning: The conclusions provide a general interpretation of the results in the context of the evidence.
[Yes]
P27. Funding
Quote: "ACKNOWLEDGEMENTS We would like to thank all trialists who provided us with additional data, preliminary manuscripts, details of methods, and references to further studies. The names of these trialists are (in alphabetical order): Dr. R.L. DeWilde (Oldenburg, Germany), Prof. S.A. Hay (Cairo, Egypt), Dr. M.T. Huang (Taipei, Taiwan), Dr. K. Karadayi (Sivas, Turkey), Dr. H. Kokki (Kuopio, Finland), Dr. M. Lavonius (Turku, Finland), Capt. Paul Lucha (Portsmouth/VA, USA), Dr. E. Macarulla (Barcelona, Spain), Dr. M. Milewczyk (Wejherowo, Poland), Dr. G. Navarra (Ferrara, Italy), Dr. K. Paya (Vienna, Austria), Prof. M.G. Sarr (Rochester/MN, USA), Dr. U. Settmacher (Berlin, Germany), Prof. A. Sezeur (Paris, France), Dr. R. Stare (Varazdin, Croatia), Dr. G. Tzovaras (Larissa, Greece), Dr. F. Vallribera Valls (Barcelona, Spain), Dr. P. Wara (Aarhus, Denmark), Prof. B.L. Warren (Tygerberg, South Africa), Dr. I. Witten and Prof. H.F. Weiser (Rotenburg/Wümme, Germany), and Dr. C.K. Yeung (Hongkong, Hongkong)."
Reasoning: The sources of funding and other support are acknowledged.
[Yes]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
1
|
0
|
1
|
0
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
0
|
0
|
1
|
0
|
0
|
1
|
0
|
0
|
0
|
0
|
1
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
0
|
NA
|
0
|
1
|
0
|
0
|
0
|
0
|
NA
|
0
|
0
|
0
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
NA
|
1
|
0
|
1
|
0
|
1
|
0
|
NA
|
1
|
1
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
0
|
0
|
0
|
1
|
0
|
0
|
0
|
0
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
0
|
1
|
0
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
LLM response
21 quote(s) from
publication full text (mean similarity 98.6%)
A1
Quote: "Our study is the first systematic review and meta-analysis comparing the laparoscopic approach to the open approach across several important outcomes."
Reasoning: The authors state this is a systematic review and meta-analysis, implying an a priori design.
[Yes]
A2
Quotes: "A systematic PubMed search was performed to identify publications that analyzed outcomes for LD or OD pull-through procedures for HD. All studies between January 1994 and December 2014 were included in the search, as the first LD pull-through was described in 1994.14"
"Data collected included study characteristics (author, journal, publication year, sample size, length of follow-up, and operative technique) and patient demographics (sex and age at surgery)."
Reasoning: The methods describe the search and data extraction process, but do not specify if this was done in duplicate.
[No]
A3
Quotes: "A systematic PubMed search was performed to identify publications that analyzed outcomes for LD or OD pull-through procedures for HD."
"Reference lists were then manually searched for additional studies."
Reasoning: PubMed was searched and reference lists were manually searched, meeting the criteria of searching at least 2 electronic databases plus a supplementary strategy.
[Yes]
A4
Reasoning: The inclusion criteria do not specify anything about publication status or grey literature.
[No]
A5
Quote: "Of these, 114 did not fulfill the inclusion criteria and were excluded (Fig. 1). Five further studies did not clearly define whether the Duhamel procedures were open or laparoscopic and were also excluded.17–21"
Reasoning: A flow diagram is provided showing the number of excluded studies with reasons, although the specific excluded studies are not listed.
[No]
A6
Quote: "Data collected included study characteristics (author, journal, publication year, sample size, length of follow-up, and operative technique) and patient demographics (sex and age at surgery)."
Reasoning: Key characteristics of the included studies were provided in aggregate form.
[Yes]
A7
Quote: "Risk of bias graph: review authors' judgments about each risk of bias item presented as percentages across all included studies."
Reasoning: A risk of bias assessment was performed and presented for the included studies.
[Yes]
A8
Reasoning: The authors do not appear to have incorporated the scientific quality/risk of bias assessment into the analysis, results or conclusions.
[No]
A9
Quotes: "Statistical heterogeneity was assessed using I2. Statistical analysis was performed using Review Manager 5.2 software (Cochrane Collaboration, London, United Kingdom)."
"The confidence interval (CI) was established at 95%, and statistical differences were considered as significant at a value of P < .05 (two tailed)."
Reasoning: Appropriate methods were used to assess heterogeneity and combine the findings of the studies.
[Yes]
A10
Reasoning: There is no mention of assessing publication bias, likely because there were fewer than 10 studies included in the meta-analysis.
[No]
A11
Reasoning: Sources of funding and conflicts of interest are not reported for the systematic review itself or the included studies.
[No]
P1
Quote: "Laparoscopic Duhamel Procedure for Hirschsprung's Disease: Systematic Review and Meta-analysis"
Reasoning: The title identifies the article as a systematic review and meta-analysis.
[Yes]
P2
Quote: See structured abstract on first page of article.
Reasoning: A structured abstract is provided with labeled sections covering the key elements.
[Yes]
P3
Quote: "Since its introduction in 1956, the Duhamel procedure has been and remains one of the most widely performed for Hirschsprung's disease (HD). The most significant modification to this procedure has been the incorporation of laparoscopy, while the original principles of the method have been retained."
Reasoning: The introduction explains the rationale for the review in the context of what is already known about the Duhamel procedure.
[Yes]
P4
Reasoning: The introduction does not provide an explicit statement of the review questions being addressed in terms of PICOS.
[No]
P5
Reasoning: No mention of a review protocol or registration.
[No]
P6
Quote: "All studies between January 1994 and December 2014 were included in the search, as the first LD pull-through was described in 1994.14 Combinations of the following search terms were used: ''Hirschsprung's disease,'' ''Duhamel,'' ''pull-through,'' ''laparoscopic,'' ''minimally invasive'' and ''open'' were used."
Reasoning: The eligibility criteria in terms of study characteristics (years considered) and report characteristics (search terms used) are provided with rationale.
[Yes]
P7
Quote: "A systematic PubMed search was performed to identify publications that analyzed outcomes for LD or OD pull-through procedures for HD. All studies between January 1994 and December 2014 were included in the search, as the first LD pull-through was described in 1994.14"
Reasoning: PubMed is stated as the electronic database searched, but the dates of coverage and last search date are not specified.
[No]
P8
Reasoning: The full search strategy is not presented in enough detail to allow replication.
[No]
P9
Quote: "Flowchart illustrating the stages of article selection."
Reasoning: A flow diagram is provided showing the process of study screening and selection.
[Yes]
P10
Reasoning: The methods do not describe the process of data extraction, such as if it was done in duplicate using standardized forms.
[No]
P11
Quote: "Data collected included study characteristics (author, journal, publication year, sample size, length of follow-up, and operative technique) and patient demographics (sex and age at surgery)."
Reasoning: The data items collected are listed, but assumptions and simplifications made are not described.
[No]
P12
Quote: "Risk of bias graph: review authors' judgments about each risk of bias item presented as percentages across all included studies."
Reasoning: A risk of bias assessment was performed for the included studies, but the methods used are not fully described.
[No]
P13
Reasoning: The principal summary measures are not explicitly stated.
[No]
P14
Quote: "Statistical heterogeneity was assessed using I2. Statistical analysis was performed using Review Manager 5.2 software (Cochrane Collaboration, London, United Kingdom)."
Reasoning: The methods used for assessing heterogeneity and combining study results are described.
[Yes]
P15
Reasoning: Methods for assessing risk of bias that may affect the cumulative evidence are not specified.
[No]
P16
Reasoning: No additional analyses are mentioned.
[NA]
P17
Quote: "Flowchart illustrating the stages of article selection."
Reasoning: A flow diagram is provided showing the number of studies screened, assessed for eligibility, included and excluded with reasons at each stage.
[Yes]
P18
Reasoning: Characteristics of individual studies are provided in the text, but a table compiling the extracted data with citations is not presented.
[No]
P19
Quote: "Risk of bias graph: review authors' judgments about each risk of bias item presented as percentages across all included studies."
Reasoning: A risk of bias assessment is presented for the included studies.
[Yes]
P20
Reasoning: For the main outcomes, only pooled effect estimates and confidence intervals are reported, not the data from each individual study.
[No]
P21
Quote: "Odds ratio for the outcome parameters incontinence/soiling and further surgery revealed a significant higher rate of incontinence/soiling and further surgery in the open Duhamel group compared with the laparoscopic Duhamel group."
Reasoning: The results of the meta-analyses are presented with effect estimates and confidence intervals.
[Yes]
P22
Reasoning: The results do not include an assessment of risk of bias across studies.
[No]
P23
Reasoning: No additional analyses were mentioned in the methods, so reporting them in the results is not applicable.
[NA]
P24
Quote: "Our meta-analysis proposes that LD pull-through is superior to OD pull-through for HD. The laparoscopic technique resulted in a significantly reduced incidence of postoperative soiling/incontinence and a reduced requirement for further surgery."
Reasoning: The main findings are summarized along with their strength of evidence and relevance to key stakeholder groups.
[Yes]
P25
Quote: "The results of our meta-analysis should be carefully interpreted. The following are unavoidable limitations:"
Reasoning: Limitations of the review are discussed at the study level (retrospective data, variable outcome definitions) and review level (surgical learning curve not accounted for).
[Yes]
P26
Quote: "Laparoscopy was first implemented in HD to obtain seromuscular biopsies,29 until the LD pull-through was described by Smith and co-workers in 1994.14 Since then, the laparoscopic approach has been reported,12–15 and there has been a trend in some institutions to move from OD to LD techniques.8,12"
Reasoning: The conclusions provide a general interpretation of the results in the context of other evidence and note implications for future practice.
[Yes]
P27
Reasoning: Sources of funding for the systematic review are not reported.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
NA
|
NA
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
0
|
0
|
1
|
0
|
0
|
1
|
0
|
0
|
1
|
NA
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
1
|
1
|
0
|
NA
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
NA
|
NA
|
1
|
0
|
0
|
0
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
0
|
0
|
0
|
1
|
0
|
0
|
NA
|
NA
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
0
|
0
|
0
|
1
|
1
|
1
|
1
|
NA
|
NA
|
0
|
LLM response
21 quote(s) from
publication full text (mean similarity 99.1%)
1
quote(s) from the LLM prompt briefing (mean similarity 100%) -
were instructions quoted (ok) or examples (unwanted beahviour)?
A1
"The PRISMA format was used for the structure of this systematic review."
The authors used the PRISMA format, which implies an a priori design.
[Yes]
A2
No relevant quotes found.
The authors do not mention duplicate study selection and data extraction.
[No]
A3
"Studies were identified by searching the electronic database MEDLINE(OVID), and by hand search of reference lists for further relevant articles. The last search was run on May 4, 2014."
The authors searched MEDLINE and reference lists, but do not mention searching additional databases.
[No]
A4
No relevant quotes found.
The authors do not mention whether they included or excluded studies based on publication status.
[No]
A5
"Fig. 1 Flow diagram. *, five additional articles included. One was included to structure systematic review. Four were included to enhance to discussion after being obtained from review of the included articles' references."
The authors provide a flow diagram showing the number of included and excluded studies.
[Yes]
A6
"For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations."
"All seven studies selected for the review were dedicated pediatric retrospective reviews (level III evidence) published in English between the years of 1980 and 2010. Mean study length was 19.3 ± 8.3 years (range, 6–30 years). Follow-up varied from 5.5 months to 22.9 years."
The authors provide aggregate characteristics of the included studies.
[Yes]
A7
"Reliability of each study was determined based on the level of evidence of each study, study design, number of patients enrolled, and length of follow-up."
The authors assessed the quality of included studies based on level of evidence, study design, sample size, and follow-up duration.
[Yes]
A8
"Conclusion Adequate comparative data are lacking to determine the ideal treatment of pediatric achalasia. Appropriately designed randomized controlled trials with long-term follow-up are needed to determine ideal treatment algorithms in pediatric achalasia."
The authors acknowledge the limitations in the evidence when formulating their conclusions.
[Yes]
A9
"Data Synthesis Seven articles were included in the systematic review. Techniques of HM and PD varied widely. The best first-line treatment of pediatric achalasia was determined to be HM in two articles, PD in one article, and equal efficacy in one article."
The authors did not perform a meta-analysis. They qualitatively synthesized the results.
[NA]
A10
No relevant quotes found.
The authors did not assess publication bias, which is appropriate since no meta-analysis was performed.
[NA]
A11
No relevant quotes found.
The authors do not report the funding sources for the included studies.
[No]
P1
"Treatment of Idiopathic Achalasia in the Pediatric Population: A Systematic Review"
The title identifies the article as a systematic review.
[Yes]
P2
The abstract has labeled sections for Background, Data Sources, Study Selection, Data Extraction, Data Synthesis, and Conclusion.
The abstract is structured with recommended headings.
[Yes]
P3
"Achalasia is a rare neuromuscular disorder of the esophagus, characterized as a syndrome of impaired relaxation of the lower esophageal sphincter (LES) and decreased peristalsis of the esophageal body. Although no cure exist that can reverse the underlying neuropathology, current treatments are aimed at symptom palliation. Management includes medication, chemical paralysis of the LES, mechanical or pneumatic dilation, endoscopic, or surgical esophagomyotomy with or without a fundoplication. Given the limited data published on pediatric achalasia, data are often limited to retrospective pediatric case series and extrapolation from the adult literature."
The introduction describes the rationale for the review in the context of what is already known.
[Yes]
P4
"Objectives We intend to delineate the best initial treatment for achalasia and synthesize the current body of literature on outcomes"
The objectives are stated, but do not explicitly reference the PICOS.
[No]
P5
No relevant quotes found.
The authors do not mention a review protocol or registration.
[No]
P6
"Types of studies: Systematic reviews and retrospective reviews were included. There were no prospective randomized trials identified in the pediatric esophageal achalasia literature.
Types of participants: Patients younger than 21 years.
Types of intervention: PD versus HM.
Types of outcomes measures: Primary outcome measure was the recommended first-line treatment of pediatric achalasia. Secondary outcome measures included type of study, level of evidence of study, length of study, diagnostic methods, number of patients, demographic information (gender and age), symptomatology, length of symptoms, procedural details, recurrence, need for further treatment, complications, and follow-up length.
Exclusion criteria: Included abstracts, case reports, small case series (less than or equal to five cases), studies limited to treatment modalities other than PD or HM, languages other than English, studies limited exclusively to syndromic achalasia, and animal or in vitro studies."
The authors specify the study characteristics and report characteristics used as criteria for eligibility.
[Yes]
P7
"Studies were identified by searching the electronic database MEDLINE(OVID), and by hand search of reference lists for further relevant articles. The last search was run on May 4, 2014."
The authors describe the electronic database searched and the date of the last search, but do not mention contacting study authors or searching additional sources.
[No]
P8
No relevant quotes found.
The authors do not present the full search strategy for any database.
[No]
P9
"Full abstracts of articles obtained by the OVID search were reviewed based on inclusion and exclusion criteria clearly delineated before the start of the review process. Full articles were then reviewed and screened. Examination of references was performed and additional articles were obtained for inclusion in the discussion."
The authors describe the process for selecting studies.
[Yes]
P10
"We developed data sheet (Microsoft Excel 2000 9.0.6926 SP-3, Microsoft Corporation) for our outcome measures listed earlier."
The authors describe using a data sheet for data collection but do not mention piloting forms, collecting data in duplicate, or obtaining data from investigators.
[No]
P11
"Primary and secondary outcomes measures listed earlier were extracted from each study."
The authors state that primary and secondary outcome measures were extracted from each study, but do not explicitly list all variables for which data were sought.
[No]
P12
"Reliability of each study was determined based on the level of evidence of each study, study design, number of patients enrolled, and length of follow-up."
The authors assessed risk of bias in individual studies and state how this information was used.
[Yes]
P13
No relevant quotes found.
The authors do not state the principal summary measures, as no meta-analysis was performed.
[NA]
P14
No relevant quotes found.
The authors did not perform a meta-analysis.
[NA]
P15
No relevant quotes found.
The authors did not assess risk of bias across studies, as no meta-analysis was performed.
[NA]
P16
No relevant quotes found.
The authors did not perform any additional analyses.
[NA]
P17
"The search of OVID database provided 103 citations. Of the remaining articles, 81 were discarded after reviewing the abstracts as they either met exclusion criteria or failed to meet full inclusion criteria. The full texts of the remaining articles were examined. Fourteen articles were eliminated, as their focus was on PD or surgical interventions alone. A total of seven studies were identified for inclusion in the systematic review. Five additional articles were included—one for systematic review structure and four were included to enhance the discussion after review of included articles' references."
The authors report the number of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, and provide a flow diagram.
[Yes]
P18
"All seven studies selected for the review were dedicated pediatric retrospective reviews (level III evidence) published in English between the years of 1980 and 2010. Mean study length was 19.3 ± 8.3 years (range, 6–30 years). Follow-up varied from 5.5 months to 22.9 years."
The authors provide aggregate characteristics for the included studies but do not present them for each individual study with citations.
[No]
P19
"Reliability of each study was determined based on the level of evidence of each study, study design, number of patients enrolled, and length of follow-up."
The authors present data on risk of bias for each study but do not provide it at the outcome level.
[No]
P20
No relevant quotes found.
The authors do not present simple summary data and effect estimates for each study.
[No]
P21
No relevant quotes found.
The authors did not perform a meta-analysis.
[NA]
P22
No relevant quotes found.
The authors did not assess risk of bias across studies, as no meta-analysis was performed.
[NA]
P23
No relevant quotes found.
The authors did not perform any additional analyses.
[NA]
P24
"The best treatment for achalasia would result in long-term symptom palliation while minimize GERD that commonly occurs after treatment. Although there are multiple treatment options, PD and HM are currently the most efficacious and most commonly used treatments. Between 1980 and 2010, there have been seven published studies that compare these two methods for the treatment of pediatric achalasia. Although both treatment options appear safe and effective, our findings support those of Lee et al who states that the current pediatric literature has provided insufficient evidence to conclude whether PD or HM is the superior first-line treatment for pediatric achalasia."
The authors summarize the main findings and their relevance to key groups.
[Yes]
P25
"Limitations Achalasia is a rare disorder resulting in small sample size which is further compounded by stratification of subjects into even smaller treatment groups. Additional limitations include surgeon preference as the deciding factor to proceed with a particular treatment except for in cases where patient size and/or age excluded a candidate for PD due to equipment limitations."
The authors discuss the limitations at the study and review level.
[Yes]
P26
"Conclusion The optimal treatment algorithm for pediatric achalasia remains unclear as adequate comparative data between PD and HM are lacking. Both adult and pediatric literatures suggest that younger age may contribute to poor response to PD. Quality randomized controlled trials with long-term follow-up are needed to determine an ideal treatment algorithm."
The authors provide a general interpretation of the results in the context of other evidence and implications for future research.
[Yes]
P27
"No funding was used."
The authors state that no funding was used for the systematic review.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
1
|
1
|
1
|
1
|
NA
|
NA
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
0
|
1
|
0
|
0
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
NA
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
1
|
1
|
1
|
NA
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
NA
|
NA
|
1
|
0
|
1
|
0
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
1
|
0
|
0
|
0
|
1
|
1
|
1
|
NA
|
NA
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
NA
|
0
|
LLM response
23 quote(s) from
publication full text (mean similarity 97.1%)
A1
"The objective of this study was to determine the prevalence of anti-reflux medication use in postoperative EA-TEF patients, and the impact of routine anti-reflux medication on postoperative GER and its associated complications."
The objective is clearly stated, but no mention of an a priori protocol.
[No]
A2
"Disagreements were settled by consensus."
"Data abstraction was performed in duplicate (AS, JD) and verified for accuracy and quality via a pre-piloted standardized data abstraction form; discrepancies were resolved by consensus."
The authors performed study selection and data extraction in duplicate.
[Yes]
A3
"A comprehensive search was conducted using MEDLINE/ PubMed, CINHAL, EMBASE/OVID, and CENTRAL (the Cochrane library) electronic databases."
"The bibliographies of relevant articles and reviews were hand-searched to title and abstract."
A comprehensive search of at least 2 databases plus hand-searching of references was done.
[Yes]
A4
"English and non-English studies were included."
Non-English studies were included in the search.
[Yes]
A5
"Of these, 25 papers (1,663 eligible patients) were eligible for inclusion and final analysis (Fig. 1) [20, 23–46]."
A flow diagram of included and excluded studies with reasons is provided.
[Yes]
A6
"All studies were small (mean number of included patients 55.4, SD 51.34 (median 61.00, min 5, max 210). There were 542 males and 395 females with EA-TEF (14 studies). Not all studies were based on EA-TEF patients;"
Aggregated characteristics of included studies are provided.
[Yes]
A7
"We performed an appraisal of the quality of reporting of the included studies in duplicate (AS and JP). We used the methodological index for non-randomized studies (MINORS) [17]."
A validated tool (MINORS) was used to assess study quality.
[Yes]
A8
"The quality of the included studies is low demonstrating important shortcomings, such as study design, small number of patients evaluated."
The low quality of studies is considered when formulating conclusions.
[Yes]
A9
This systematic review did not perform a meta-analysis.
[NA]
A10
This systematic review did not perform a meta-analysis.
[NA]
A11
"None."
The authors declare no conflicts of interest. However, sources of funding for the systematic review and included studies are not reported.
[No]
P1
"The management of postoperative reflux in congenital esophageal atresia–tracheoesophageal fistula: a systematic review"
The title identifies the article as a systematic review.
[Yes]
P2
The abstract is structured with labeled sections for background, methods, results, and conclusion. However, it is missing some recommended elements like objectives.
[No]
P3
"Esophageal atresia (EA) with or without tracheoesophageal fistula (TEF) is often associated with postoperative tracheoesophageal reflux (GER). GER is attributed to an inherent dysmotility of the esophagus, a patulous lower esophageal sphincter, a foreshortened intra-abdominal esophagus, damage to the vagus nerve during surgery or secondary to anatomic changes created at anastomosis [1–5]."
Relevant background information is provided to introduce the rationale for the review.
[Yes]
P4
"The objective of this study was to determine the prevalence of anti-reflux medication use in postoperative EA-TEF patients, and the impact of routine anti-reflux medication on postoperative GER and its associated complications."
The objective is stated, but does not explicitly reference the PICOS elements.
[No]
P5
No mention of a review protocol or registration.
[No]
P6
"Studies were included if they fulfilled the following criteria: (1) published between inception of database and November 2012, (2) primary diagnosis of EA with or without TEF, (3) secondary diagnosis of postoperative GER, (4) primary treatment for GER with antireflux medications (not limited by type of agent, dose or mode of delivery). Case reports, case series with \5 eligible subjects, and review articles were excluded. English and non-English studies were included."
Eligibility criteria are specified.
[Yes]
P7
"A comprehensive search was conducted using MEDLINE/ PubMed, CINHAL, EMBASE/OVID, and CENTRAL (the Cochrane library) electronic databases. Initially identified studies were then filtered on the basis of predetermined relevant Medical Subject Heading (MeSH) terms and keywords (esophageal atresia, tracheoesophageal fistula, gastroesophageal reflux). Gray literature was searched in Papers first, Proceedings first and Pro Quest electronic databases (key word search) for the same time period."
Information sources and dates searched are described.
[Yes]
P8
No full search strategy is presented.
[No]
P9
"The bibliographies of relevant articles and reviews were hand-searched to title and abstract."
The study selection process is described.
[Yes]
P10
"Data abstraction was performed in duplicate (AS, JD) and verified for accuracy and quality via a pre-piloted standardized data abstraction form; discrepancies were resolved by consensus."
The data collection process is described.
[Yes]
P11
No list of all variables for which data were sought is provided.
[No]
P12
"We performed an appraisal of the quality of reporting of the included studies in duplicate (AS and JP). We used the methodological index for non-randomized studies (MINORS) [17]."
The method of assessing risk of bias is described.
[Yes]
P13
No summary measures are specified, as no quantitative synthesis was performed.
[NA]
P14
No quantitative synthesis was performed.
[NA]
P15
No quantitative synthesis was performed.
[NA]
P16
No additional analyses were performed.
[NA]
P17
"Of these, 25 papers (1,663 eligible patients) were eligible for inclusion and final analysis (Fig. 1) [20, 23–46]."
A flow diagram is provided with the numbers of studies at each stage.
[Yes]
P18
"Study characteristics are presented in Table 1."
Study characteristics are presented but individual study citations are not provided.
[No]
P19
"We performed an appraisal of the quality of reporting of the included studies in duplicate (AS and JP). We used the methodological index for non-randomized studies (MINORS) [17]."
Results of the risk of bias assessment are presented in Figure 3.
[Yes]
P20
Results for individual studies are not presented.
[No]
P21
No meta-analysis was performed.
[NA]
P22
No meta-analysis was performed.
[NA]
P23
No additional analyses were performed.
[NA]
P24
"We identified 25 observational studies that met criteria for inclusion in this systematic review on the use of anti-reflux medication in postoperative EA-TEF patients, and the impact of routine anti-reflux medication on postoperative GER and its associated complications. EA-TEF remains a heterogeneous condition, with a spectrum of anomalies, associated comorbidities and outcomes."
The main findings are summarized.
[Yes]
P25
"The quality of the included studies is low demonstrating important shortcomings, such as study design, small number of patients evaluated, heterogeneous patients evaluated, and lack of a clear definition of outcomes."
Limitations at the study and review level are discussed.
[Yes]
P26
"Collaboration with other centers and experts in the field to develop databases with standardized reporting forms would improve the data collection and subsequent analysis of the outcomes of these patients. Consistent and reliable outcome reporting including definitions of outcomes, best diagnostic criteria, use of reporting checklists for study design and reporting, and adequate follow-up will be necessary for the development of treatment guidelines [73–75]."
A general interpretation is provided in the context of other evidence and implications for future research are discussed.
[Yes]
P27
"None."
Sources of funding are not described.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
1
|
1
|
1
|
0
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
0
|
1
|
0
|
0
|
1
|
1
|
0
|
1
|
0
|
1
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
0
|
0
|
0
|
1
|
0
|
1
|
1
|
0
|
0
|
1
|
1
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
0
|
1
|
1
|
0
|
0
|
1
|
NA
|
NA
|
1
|
0
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
0
|
0
|
0
|
1
|
1
|
1
|
1
|
0
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
1
|
0
|
0
|
0
|
1
|
1
|
0
|
1
|
NA
|
0
|
LLM response
21 quote(s) from
publication full text (mean similarity 99.7%)
A1 - A priori design
Quote: "The key words used in the search were as follows: laparoscopic, open, hepaticojejunostomy, choledochal cysts. The language was restricted to English only."
Reasoning: The search keywords are specified, suggesting an a priori design, but no explicit protocol is mentioned.
[No]
A2 - Duplicate study selection and data extraction
Quotes: "Two reviewers (Huo-Jian Shen and Ming Xu) abstracted relevant information from each eligible article using a standardized form independently. Information about the characteristics of the study population, authors, publication year, study period, country, sample size, interventions, outcomes details of the surgical techniques used, and relevant outcomes were recorded. Disagreements between reviewers regarding data abstraction were resolved through discussion."
Reasoning: Two independent reviewers selected studies and extracted data, with a process for resolving disagreements.
[Yes]
A3 - Comprehensive literature search
Quotes: "We searched databases, including PubMed, Embase, the Science Citation Index, and Cochrane Library updated to November 2014, to identify all related published studies comparing the laparoscopic and the open choledochal cyst excision with hepaticojejunostomy."
"The key words used in the search were as follows: laparoscopic, open, hepaticojejunostomy, choledochal cysts. The language was restricted to English only."
Reasoning: At least two databases were searched using relevant keywords. The search was restricted to English language only.
[No]
A4 - Grey literature
Reasoning: No mention of searching for grey literature or unpublished studies.
[No]
A5 - List of included and excluded studies
Quote: "According to the search strategy described previously, a total of 162 citations were obtained for review of title and abstract (Fig. 1). Of the 162 citations, 14 duplicates were removed by the Endnote X5 software, and 131 irrelevant studies were excluded through scanning titles and abstracts. Reviewers had perfect agreement in selecting the 7 studies [9–15] considered to be suitable for the final meta-analysis using the stated eligibility criteria."
Reasoning: A flow diagram of study selection is provided, but no list of excluded studies is given.
[No]
A6 - Characteristics of included studies
Quote: "All 7 included studies are retrospective series. They included total of 1016 patients. Of these, 408 (40.16 %) underwent LH, and 608 (59.84 %) had OH. The characteristics, quality assessment, and outcomes for the included studies are summarized in Table 1."
Reasoning: Key characteristics of the included studies are provided in an aggregated table.
[Yes]
A7 - Quality assessment of included studies
Quote: "The quality of the literature was assessed independently by two authors (Huo-Jian Shen and Ming Xu) using the 9-star Newcastle–Ottawa Scale [7]. A full score is 9 stars, and a score ≥6 stars is considered to be high quality."
Reasoning: The Newcastle-Ottawa Scale was used by two independent reviewers to assess study quality.
[Yes]
A8 - Quality used in formulating conclusions
Reasoning: The authors do not appear to consider the quality assessment when formulating conclusions or making recommendations.
[No]
A9 - Methods for combining studies
Quotes: "Heterogeneity was assessed using the I2 statistic. The heterogeneity among the studies was evaluated using the Mantel–Haenszel Chi-squared test, with its significance set at P < 0.1, and the extent of inconsistency was assessed by the I2 statistic [8]. I2 values of <25 % were defined as low heterogeneity. Those between 25 and 50 % were defined as moderate heterogeneity and those >50 % as high heterogeneity. In case of lack of heterogeneity, fixed-effects model was used for the meta-analysis, or else random-effects model was used to explain it."
Reasoning: Heterogeneity was assessed using I2 and the chi-squared test. Fixed or random effects models were used depending on heterogeneity.
[Yes]
A10 - Publication bias
Reasoning: Publication bias was not assessed, likely because there were fewer than 10 studies.
[NA]
A11 - Conflicts of interest
Reasoning: The authors declare no conflicts of interest for the systematic review, but conflicts of interest for the included studies are not reported.
[No]
P1 - Title
Quote: "Laparoscopic versus open surgery in children with choledochal cysts: a meta-analysis"
Reasoning: The title identifies the article as a meta-analysis.
[Yes]
P2 - Structured abstract
Reasoning: The abstract has distinct labeled sections for objective, methods, results, and conclusion.
[Yes]
P3 - Rationale
Quote: "Choledochal cysts are rare congenital cystic dilations of the biliary tree that present primarily in female infants and young children and are more prevalent in East Asian populations [1, 2]. The exact etiology of choledochal cysts is unknown, but anomalous pancreaticobiliary duct union (APBDU) is seen in 30–70 % of all choledochal cysts where the common bile duct (CBD) and pancreatic duct junction occurs outside the duodenum, allowing the reflux of pancreatic fluid into the biliary tree [3]."
Reasoning: The introduction provides context on the epidemiology and etiology of choledochal cysts.
[Yes]
P4 - Objectives
Quote: "Objective To compare the safety and efficacy between laparoscopic and open cyst excision with hepaticojejunostomy for children with choledochal cysts using meta-analysis."
Reasoning: The objective specifies the PICO elements.
[Yes]
P5 - Protocol and registration
Reasoning: No mention of a protocol or registration number.
[No]
P6 - Eligibility criteria
Quote: "The studies that published up to and including November 2014 were considered eligible if they met the following inclusion criteria: (1) study reported on at least one of the outcome measures mentioned below: operative time, intraoperative blood loss, time to food intake, postoperative morbidity (including bile leakage, pancreatic leakage, cholangitis, pancreatitis, adhesive intestinal obstruction, abdominal bleeding, etc.,) and mortality, length of hospital stay."
Reasoning: Eligibility criteria are specified in terms of study design, outcomes, and publication date.
[Yes]
P7 - Information sources
Quote: "We searched databases, including PubMed, Embase, the Science Citation Index, and Cochrane Library updated to November 2014, to identify all related published studies comparing the laparoscopic and the open choledochal cyst excision with hepaticojejunostomy."
Reasoning: Databases searched are listed but the date last searched is not provided.
[No]
P8 - Search
Quote: "The key words used in the search were as follows: laparoscopic, open, hepaticojejunostomy, choledochal cysts. The language was restricted to English only."
Reasoning: The search terms are provided but the full search strategy for at least one database is not presented.
[No]
P9 - Study selection
Quote: "Two reviewers (Huo-Jian Shen and Ming Xu) abstracted relevant information from each eligible article using a standardized form independently."
Reasoning: The study selection process is described and was done independently by two reviewers.
[Yes]
P10 - Data collection process
Quote: "Two reviewers (Huo-Jian Shen and Ming Xu) abstracted relevant information from each eligible article using a standardized form independently. Information about the characteristics of the study population, authors, publication year, study period, country, sample size, interventions, outcomes details of the surgical techniques used, and relevant outcomes were recorded. Disagreements between reviewers regarding data abstraction were resolved through discussion."
Reasoning: Data extraction was done independently by two reviewers using a standardized form, with disagreements resolved by discussion.
[Yes]
P11 - Data items
Reasoning: The variables for which data were sought are not explicitly defined.
[No]
P12 - Risk of bias in individual studies
Quote: "The quality of the literature was assessed independently by two authors (Huo-Jian Shen and Ming Xu) using the 9-star Newcastle–Ottawa Scale [7]. A full score is 9 stars, and a score ≥6 stars is considered to be high quality."
Reasoning: The Newcastle-Ottawa Scale was used to assess risk of bias in the included studies.
[Yes]
P13 - Summary measures
Reasoning: The principal summary measures (e.g. risk ratio, mean difference) are not explicitly stated.
[No]
P14 - Synthesis of results
Quotes: "Heterogeneity was assessed using the I2 statistic. The heterogeneity among the studies was evaluated using the Mantel–Haenszel Chi-squared test, with its significance set at P < 0.1, and the extent of inconsistency was assessed by the I2 statistic [8]. I2 values of <25 % were defined as low heterogeneity. Those between 25 and 50 % were defined as moderate heterogeneity and those >50 % as high heterogeneity. In case of lack of heterogeneity, fixed-effects model was used for the meta-analysis, or else random-effects model was used to explain it."
Reasoning: Methods for assessing heterogeneity and deciding on fixed vs random effects models are described.
[Yes]
P15 - Risk of bias across studies
Reasoning: No methods for assessing risk of bias across studies (e.g. publication bias) are specified.
[No]
P16 - Additional analyses
Reasoning: No additional analyses such as subgroup analyses or meta-regression are mentioned.
[No]
P17 - Study selection
Quote: "According to the search strategy described previously, a total of 162 citations were obtained for review of title and abstract (Fig. 1). Of the 162 citations, 14 duplicates were removed by the Endnote X5 software, and 131 irrelevant studies were excluded through scanning titles and abstracts. Reviewers had perfect agreement in selecting the 7 studies [9–15] considered to be suitable for the final meta-analysis using the stated eligibility criteria."
Reasoning: A flow diagram presents the number of studies screened, assessed for eligibility, and included.
[Yes]
P18 - Study characteristics
Quote: "The characteristics, quality assessment, and outcomes for the included studies are summarized in Table 1."
Reasoning: A table of characteristics for the included studies is provided.
[Yes]
P19 - Risk of bias within studies
Reasoning: The quality assessment results for each included study are not presented.
[No]
P20 - Results of individual studies
Reasoning: For the outcomes meta-analyzed, forest plots showing the results of individual studies are not provided.
[No]
P21 - Synthesis of results
Reasoning: Meta-analysis results with confidence intervals and measures of consistency are reported for several outcomes.
[Yes]
P22 - Risk of bias across studies
Reasoning: Results of any assessment of risk of bias across studies (e.g. publication bias) are not reported.
[NA]
P23 - Additional analyses
Reasoning: No additional analyses such as subgroup analyses or meta-regression were reported.
[NA]
P24 - Summary of evidence
Quotes: "The incidence of choledochal cysts is approximately 1 in 100,000–150,000 live births in Western countries [16] and 1 in 13,000 individuals in Japan [17]. About 80 % of choledochal cysts are diagnosed in childhood within the first decade of life [18, 19]. Since choledochal cysts can confer significant morbidity in childhood and have a high risk of biliary tract malignancy in adulthood [20], early diagnosis and treatment is very important. The optimal definitive treatment is complete excision of cysts with Roux-en-Y hepaticojejunostomy. Laparoscopic approach to choledochal cysts was first described by Farelo et al. [6] in a 6-year-old child. Since then, it has become popular and evolved at an unprecedented pace in many centers for the treatment of children with choledochal cysts [21, 22]."
Reasoning: The main findings are summarized, including their relevance to patients and providers.
[Yes]
P25 - Limitations
Reasoning: Limitations at the study, outcome, and review level are not discussed.
[No]
P26 - Conclusions
Quote: "In the treatment of children with choledochal cysts by laparoscopic surgery, we think it has a variety of advantages. First, laparoscopic techniques provide a better vision of the deep anatomic structures and avoid injuring the surrounding organs, especially in childhood because of the small abdominal cavity space; second, decreased postoperative pain and small incision are beneficial to the growth of children in psychological; third, less blood loss and a quicker recovery of gastrointestinal function are also beneficial to the growth of children in physiological."
Reasoning: The conclusion provides a general interpretation of the results and implications for practice.
[Yes]
P27 - Funding
Reasoning: Sources of funding and support for the systematic review are not described.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
1
|
1
|
1
|
0
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
NA
|
NA
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
1
|
1
|
1
|
NA
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
NA
|
0
|
0
|
0
|
0
|
NA
|
0
|
NA
|
1
|
1
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
1
|
0
|
0
|
1
|
1
|
1
|
NA
|
NA
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
0
|
0
|
0
|
0
|
0
|
1
|
1
|
NA
|
NA
|
0
|
LLM response
25 quote(s) from
publication full text (mean similarity 98.9%)
A1
Quote: "Objective: Surgery for pediatric idiopathic constipation (IC) is undertaken after failure of bowel management programs. Decisions are influenced by rectal biopsy, transit studies, megacolon/megarectum, degree of soiling/ incontinence, and anorectal manometry profile(s). A systematic review of ALL published studies critically evaluates outcomes of surgery for IC."
The objective clearly states the research question and inclusion criteria.
[Yes]
A2
No information provided on duplicate study selection and data extraction.
[No]
A3
Quotes: "MEDLINE (PubMed), Google Scholar, and EMBase were searched for English-language articles only. Studies included (1) peer-review publications with 3 or more patients, and (2) clinical outcomes defined by authors."
"Forty-five reports (1157 patients) met full inclusion criteria. Only 2 papers were randomized controlled trials. Many had small patient numbers (median n = 16; range: 3–114)."
Multiple databases were searched and supplemented by inclusion criteria. However, no search terms, years, or full search strategy were provided.
[No]
A4
Quote: "MEDLINE (PubMed), Google Scholar, and EMBase were searched for English-language articles only."
Only English language articles were included, but no mention of including grey literature.
[No]
A5
The full texts of excluded studies were not provided, only the number of included studies and patients.
[No]
A6
Quote: "Most studies involved small numbers of patients (median n = 16; range: 3–114). Thirty-two of 45 studies provided specific data on patient age with only 19 studies reporting patient or male or female sex with 55% IC cases being males. Forty studies stated "medical failure" as the primary indication for surgical intervention."
Some aggregate characteristics of included studies like number of patients, age and sex were provided, but more details could have been reported.
[No]
A7
Quote: "Crucially, we identified only 6 publications where a comprehensive anatomical and physiological "work-up" was undertaken before embarking on surgery for IC. Excluding colorectal pathology by rectal biopsy is mandatory in defining pediatric IC. Sixteen publications (35%) failed to indicate whether any patient(s) had undergone evaluation with rectal biopsy."
The scientific quality of included studies was assessed in terms of whether they did a comprehensive anatomical and physiological workup before surgery.
[Yes]
A8
Quote: "Outcomes showed wide variability in the many studies published. Success was defined by study authors as (1) alleviation of clinical symptoms (58%), (2) reduction in requirement for laxatives (45%), (3) improved bowel frequency (45%), and (4) ongoing use of ACE stoma (8%). Parent and carer satisfaction was documented in 18% of studies through interview or questionnaires. Quality of life scores (35%) including validated disease assessment tools (9%) were also reported. Clinical outcome metrics allowing for a more objective assessment (manometry, contrast enema, or defecography) were utilized in only 6 studies (13%). Median length of follow-up was 4 years."
The variable quality of included studies was considered when discussing the heterogeneous outcomes reported.
[Yes]
A9
Meta-analysis was not conducted.
[NA]
A10
Publication bias was not assessed.
[NA]
A11
Quote: "Disclosure: The authors have no conflicts of interest."
Conflicts of interest were reported for the systematic review authors but not for the included studies.
[No]
P1
Quote: "Current Surgical Management of Pediatric Idiopathic Constipation: A Systematic Review of Published Studies"
The title identifies the article as a systematic review.
[Yes]
P2
The abstract has labeled sections for background, objective, methods, results, and conclusions.
[Yes]
P3
Quote: "Children with refractory idiopathic constipation (IC)/soiling, resistant to intensive medical management and bowel training programs, are a major challenge for pediatric surgeons worldwide. Operations to reduce the chronic debility of this illness may involve a wide range of therapy options guided by rectal biopsy, intestinal transit study, anorectal manometry profile, and radiology to better define the severity of megarectum and megacolon resulting from gut dysmotility (Fig. 1). These include the antegrade continence enema (ACE) operation, segmental or total colonic resection, Duhamel pull-through, and sphincter myectomy, or a permanent abdominal stoma diverting colostomy stoma."
The introduction describes the rationale for the review in the context of what is already known about surgical management of refractory pediatric constipation.
[Yes]
P4
Quote: "Objective: Surgery for pediatric idiopathic constipation (IC) is undertaken after failure of bowel management programs. Decisions are influenced by rectal biopsy, transit studies, megacolon/megarectum, degree of soiling/ incontinence, and anorectal manometry profile(s). A systematic review of ALL published studies critically evaluates outcomes of surgery for IC."
The objective provides an explicit statement of the review question, with reference to the population (pediatric idiopathic constipation), interventions (surgery), and outcomes of interest.
[Yes]
P5
No mention of a review protocol or registration.
[No]
P6
Quote: "Forty-five reports (1157 patients) met full inclusion criteria. Only 2 papers were randomized controlled trials. Many had small patient numbers (median n = 16; range: 3–114). Twenty-three described heterogenous populations with variant pathology. Follow-up was short (median = 1.5 years; range: 3 months–14 years). The antegrade continence enema operation (ACE)—[open/laparoscopic assisted, cecostomy, or "left sided" ACE]— was judged as successful in 82% of cases, although high morbidity and reoperation rates were reported. Colon resection and pull through operations had "good" outcome(s) in 79% of children with 17% reporting significant morbidity and a 10% incidence of revisional surgery. Anal dilatation did not improve outcome(s). Botulinum toxin injection scored equally effective compared to internal sphincter myectomy in short-term follow-up. Permanent colostomy was considered successful in 86% of refractory IC cases."
Eligibility criteria are provided in terms of study designs, patient population, interventions, and outcomes. No rationale is given for the choices.
[No]
P7
Quote: "MEDLINE (PubMed), Google Scholar, and EMBase were searched for English-language articles only. Studies included (1) peer-review publications with 3 or more patients, and (2) clinical outcomes defined by authors."
Information sources are described but the years searched and date last searched are not provided.
[No]
P8
No search strategy provided.
[No]
P9
The study selection process is not described in adequate detail.
[No]
P10
No information is provided on the data collection process.
[No]
P11
Quote: "Forty-five reports (1157 patients) met full inclusion criteria. Only 2 papers were randomized controlled trials. Many had small patient numbers (median n = 16; range: 3–114). Twenty-three described heterogenous populations with variant pathology. Follow-up was short (median = 1.5 years; range: 3 months–14 years)."
Some data items that were extracted are mentioned, like number of patients, study design, follow-up duration, but a full list is not provided.
[No]
P12
Quote: "Crucially, we identified only 6 publications where a comprehensive anatomical and physiological "work-up" was undertaken before embarking on surgery for IC. Excluding colorectal pathology by rectal biopsy is mandatory in defining pediatric IC. Sixteen publications (35%) failed to indicate whether any patient(s) had undergone evaluation with rectal biopsy."
Risk of bias was assessed in terms of whether studies did a comprehensive workup before surgery, but the methods are not described in detail.
[No]
P13
No summary measures are stated.
[No]
P14
Meta-analysis was not performed.
[NA]
P15
Risk of bias across studies was not assessed.
[No]
P16
No additional analyses were reported.
[NA]
P17
A flow diagram of study selection was not provided. The total number of included studies and patients was reported, but not the numbers screened or excluded with reasons.
[No]
P18
Characteristics of individual included studies were not provided, only some aggregate characteristics.
[No]
P19
Quote: "Crucially, we identified only 6 publications where a comprehensive anatomical and physiological "work-up" was undertaken before embarking on surgery for IC. Excluding colorectal pathology by rectal biopsy is mandatory in defining pediatric IC. Sixteen publications (35%) failed to indicate whether any patient(s) had undergone evaluation with rectal biopsy."
Risk of bias was reported in aggregate but not for each individual study.
[No]
P20
Results for individual studies were not provided, only aggregate results across studies.
[No]
P21
Meta-analysis was not performed.
[NA]
P22
Risk of bias across studies was not assessed.
[No]
P23
No additional analyses were reported.
[NA]
P24
Quotes: "Outcomes showed wide variability in the many studies published. Success was defined by study authors as (1) alleviation of clinical symptoms (58%), (2) reduction in requirement for laxatives (45%), (3) improved bowel frequency (45%), and (4) ongoing use of ACE stoma (8%). Parent and carer satisfaction was documented in 18% of studies through interview or questionnaires. Quality of life scores (35%) including validated disease assessment tools (9%) were also reported."
"A permanent stoma should be considered the last therapy option in pediatric IC. Restoration of colorectal anatomy has not always been successful."
The main findings are summarized, including the variability in outcome definitions and the overall success rates of the surgical interventions.
[Yes]
P25
Quote: "Defining "success" or "failure" of the many surgical operations described for IC was highly variable. Most authors defined success on the basis of the subjective or qualitative interpretation of improvements in bowel habit or continence along with the decreased requirement for laxatives. To this end, only (8%) publications had validated scoring systems to assess quality of life after interventions."
Limitations such as the variable definitions of success/failure and lack of validated outcome measures are discussed.
[Yes]
P26
Quote: "The literature search after applying filters with application of inclusion/exclusion criteria retrieved 45 complete studies for final analysis (Fig. 2). An outline of studies is illustrated in Table 1. All 45 studies were published during the years 1966 to 2014. Only 2 studies (4.4%) were randomized controlled trials (RCTs); 3 studies (6.6%) included control groups for comparison of outcomes and 6 studies (13%) were prospective in design."
The conclusion provides a general interpretation that the evidence base consists largely of retrospective case series, with few RCTs or controlled studies.
[Yes]
P27
Quote: "Disclosure: The authors have no conflicts of interest."
Sources of funding for the systematic review are disclosed, but not the role of funders.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
0
|
0
|
0
|
0
|
0
|
1
|
0
|
1
|
1
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
0
|
1
|
0
|
0
|
1
|
0
|
0
|
1
|
0
|
1
|
1
|
0
|
1
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
0
|
NA
|
1
|
0
|
1
|
1
|
1
|
0
|
NA
|
1
|
0
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
NA
|
0
|
0
|
0
|
0
|
0
|
1
|
NA
|
NA
|
1
|
1
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
0
|
0
|
0
|
1
|
1
|
1
|
1
|
0
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
1
|
0
|
1
|
0
|
1
|
1
|
1
|
1
|
NA
|
0
|
LLM response
27 quote(s) from
publication full text (mean similarity 99.6%)
A1
Quote: "We performed a meta-analysis to combine our data with the published literature."
Reasoning: The authors mention performing a meta-analysis, but do not explicitly state that the research question and inclusion criteria were established a priori.
[No]
A2
Quotes: "Two researchers independently screened the title and abstract of identified articles for potential eligibility and retrieved the full-text version of all articles deemed relevant. They then assessed the full-text articles for relevance and hand-searched the bibliographies of selected studies to identify additional articles. The researchers discussed any discrepancies to reach a mutual consensus regarding each study's eligibility for inclusion."
"Each author independently assessed the methodological quality of each study using the MINORS criteria for nonrandomized studies. This scale comprises 12 items, with a maximum total score of 24. Higher scores indicate better methodological quality."
Reasoning: The authors describe using two independent researchers for study selection and quality assessment.
[Yes]
A3
Quotes: "To identify all publications comparing LAP versus open surgery for intussusception in children, two researchers independently searched the electronic databases MEDLINE, Embase, CINAHL, and the Cochrane Library, using the MeSH terms "intussusception," "pediatric," and "laparoscopic.""
"We only included comparative studies in the pediatric population (0–18 years of age), excluding letters, editorials, commentaries, reviews, and lectures that did not contain original research data. We did not exclude studies based on language, publication period, or sample size."
Reasoning: The authors searched multiple electronic databases and defined search terms, but did not mention supplementing the electronic search with other methods like reviewing references or consulting experts.
[No]
A4
Quote: "We did not exclude studies based on language, publication period, or sample size."
Reasoning: The authors explicitly state that studies were not excluded based on publication status.
[Yes]
A5
Quote: "Two researchers independently screened the title and abstract of identified articles for potential eligibility and retrieved the full-text version of all articles deemed relevant. They then assessed the full-text articles for relevance and hand-searched the bibliographies of selected studies to identify additional articles."
Reasoning: The authors describe the process of study selection but do not provide a list of excluded studies.
[No]
A6
Quote: "The demographics and outcomes of both groups are presented in Table 1."
Reasoning: The authors provide the characteristics of included studies in an aggregated form in Table 1.
[Yes]
A7
Quote: "Each author independently assessed the methodological quality of each study using the MINORS criteria for nonrandomized studies. This scale comprises 12 items, with a maximum total score of 24. Higher scores indicate better methodological quality."
Reasoning: The authors independently assessed study quality using the MINORS tool.
[Yes]
A8
Quotes: "Our meta-analysis identified five retrospective studies comparing LAP and open techniques for reduction of intussusception. We did not find a significant difference between groups with respect to operative time, conversion to open operation rates, or length of hospital stay."
"However, the length of hospital stay was significantly longer in the open group."
Reasoning: The authors considered study quality when interpreting the results, noting the retrospective nature of included studies and that one outcome differed between groups.
[Yes]
A9
Quote: "We performed statistical analysis using the Med Calc statistical software. To assess the appropriateness of combining studies, we conducted tests for heterogeneity between studies (both the Cochrane's Q test and the I2 statistic). If the results of these tests showed minimal heterogeneity (I2 < 50% for the Q test, >50% heterogeneity with the I2 statistic), we used a random effects model for meta-analysis. We analyzed continuous data as weighted mean differences and dichotomous outcomes as odds ratios, using 95% confidence intervals for all analyses."
Reasoning: The authors assessed heterogeneity to determine the appropriateness of combining studies and used a random effects model.
[Yes]
A10
Reasoning: The authors do not mention assessing the likelihood of publication bias.
[NA] - Publication bias was not assessed, likely because there were fewer than 10 studies, making assessment not feasible.
A11
Reasoning: The authors do not report the sources of funding or conflicts of interest for the included studies. They provide a disclosure statement for the systematic review itself.
[No]
P1
Quote: "Laparoscopic Versus Open Reduction of Intussusception in Children: A Retrospective Review and Meta-analysis"
Reasoning: The title identifies the article as a retrospective review and meta-analysis.
[Yes]
P2
Reasoning: The article does not contain a structured abstract with labeled sections for background, objectives, data sources, etc.
[No]
P3
Quote: "Intestinal intussusception is a frequent cause of bowel obstruction in children. Initial treatment involves pneumatic reduction. If this fails, operative reduction is indicated. There is controversy regarding use of the laparoscopic (LAP) versus the conventional open approach."
Reasoning: The authors describe the rationale for the review in the context of existing knowledge on treatment of intussusception in children.
[Yes]
P4
Quote: "We performed a meta-analysis to combine our data with the published literature."
Reasoning: The authors state the aim to perform a meta-analysis combining their data with published studies, but do not provide an explicit, detailed PICOS statement of the review question.
[No]
P5
Reasoning: The authors do not mention if a review protocol exists or where it can be accessed.
[No]
P6
Quotes: "We only included comparative studies in the pediatric population (0–18 years of age), excluding letters, editorials, commentaries, reviews, and lectures that did not contain original research data. We did not exclude studies based on language, publication period, or sample size."
"After receiving research ethics board approval from our institution, we retrospectively reviewed the electronic and paper charts of all patients requiring operative intervention for intussusception. Patient demographics such as age, weight, and sex were recorded. Perioperative data collected included operative approach, conversion, bowel resection, intraoperative complications, and surgical time. Conversion was defined as instances where an incision was extended to facilitate reduction of the intussusception. LOS, time to first feeds, time to full feeds, postoperative complications, length of follow-up, and recurrence were documented."
Reasoning: The authors specify the study characteristics (pediatric comparative studies) and report characteristics (no limits on language, publication period, sample size) used as eligibility criteria.
[Yes]
P7
Quotes: "To identify all publications comparing LAP versus open surgery for intussusception in children, two researchers independently searched the electronic databases MEDLINE, Embase, CINAHL, and the Cochrane Library, using the MeSH terms "intussusception," "pediatric," and "laparoscopic.""
"After receiving research ethics board approval from our institution, we retrospectively reviewed the electronic and paper charts of all patients requiring operative intervention for intussusception."
Reasoning: The authors describe the electronic databases searched for the systematic review and the institutional chart review, but do not specify the dates of coverage or last search date.
[No]
P8
Reasoning: The authors do not present the full electronic search strategy for any of the databases.
[No]
P9
Quote: "Two researchers independently screened the title and abstract of identified articles for potential eligibility and retrieved the full-text version of all articles deemed relevant. They then assessed the full-text articles for relevance and hand-searched the bibliographies of selected studies to identify additional articles. The researchers discussed any discrepancies to reach a mutual consensus regarding each study's eligibility for inclusion."
Reasoning: The authors describe the process of screening titles/abstracts, assessing full-text articles for eligibility, and resolving discrepancies between reviewers.
[Yes]
P10
Reasoning: The authors do not describe the method of data extraction in detail, such as if a standardized form was used, if it was done in duplicate, or if any data was obtained from study investigators.
[No]
P11
Quote: "After receiving research ethics board approval from our institution, we retrospectively reviewed the electronic and paper charts of all patients requiring operative intervention for intussusception. Patient demographics such as age, weight, and sex were recorded. Perioperative data collected included operative approach, conversion, bowel resection, intraoperative complications, and surgical time. Conversion was defined as instances where an incision was extended to facilitate reduction of the intussusception. LOS, time to first feeds, time to full feeds, postoperative complications, length of follow-up, and recurrence were documented."
Reasoning: The authors list the variables for which data was collected from the institutional chart review.
[Yes]
P12
Quote: "Each author independently assessed the methodological quality of each study using the MINORS criteria for nonrandomized studies. This scale comprises 12 items, with a maximum total score of 24. Higher scores indicate better methodological quality."
Reasoning: The authors describe using the MINORS tool to assess risk of bias in the included studies.
[Yes]
P13
Reasoning: The authors do not explicitly state the principal summary measures, though they report odds ratios, mean differences, and confidence intervals in the results.
[No]
P14
Quote: "We performed statistical analysis using the Med Calc statistical software. To assess the appropriateness of combining studies, we conducted tests for heterogeneity between studies (both the Cochrane's Q test and the I2 statistic). If the results of these tests showed minimal heterogeneity (I2 < 50% for the Q test, >50% heterogeneity with the I2 statistic), we used a random effects model for meta-analysis. We analyzed continuous data as weighted mean differences and dichotomous outcomes as odds ratios, using 95% confidence intervals for all analyses."
Reasoning: The authors describe assessing heterogeneity and using a random effects model for meta-analysis.
[Yes]
P15
Reasoning: The authors do not mention any assessment of risk of bias across studies, such as publication bias or selective reporting.
[NA] - Likely not applicable as publication bias assessment may not have been feasible with <10 included studies.
P16
Reasoning: The authors do not describe any additional analyses like sensitivity analysis, subgroup analysis, or meta-regression.
[No]
P17
Quote: "Our electronic search identified 40 studies. After applying our exclusion criteria we excluded 35 studies, leaving five retrospective cohort studies for analysis (Fig. 1)."
Reasoning: The authors provide the number of studies screened, excluded, and included, but do not show the full flow with reasons for exclusions at each stage.
[No]
P18
Reasoning: The authors present the aggregated characteristics of included studies in Table 1 but do not provide characteristics and citations for each individual study.
[No]
P19
Reasoning: The authors do not present risk of bias assessments for each individual study, only an overall methodological quality score from the MINORS tool.
[No]
P20
Reasoning: The authors present forest plots with odds ratios and confidence intervals for each study for some outcomes, but do not include the raw summary data for each intervention group.
[No]
P21
Reasoning: The authors present forest plots with pooled odds ratios and confidence intervals for the meta-analyses.
[Yes]
P22
Reasoning: The authors do not report any assessment of risk of bias across studies.
[NA] - Likely not applicable as the risk of bias across studies may not have been feasible to assess with <10 included studies.
P23
Reasoning: The authors do not report any additional analyses.
[NA] - No additional analyses were mentioned.
P24
Quotes: "Our meta-analysis identified five retrospective studies comparing LAP and open techniques for reduction of intussusception. We did not find a significant difference between groups with respect to operative time, conversion to open operation rates, or length of hospital stay."
"However, the length of hospital stay was significantly longer in the open group."
Reasoning: The authors summarize the main findings and note the retrospective nature of the evidence.
[Yes]
P25
Quote: "The current literature on this topic is limited to retrospective studies, which are inherently limited by methodological bias. Most retrospective designs do not use blinding for outcome assessment, and many do not use a standardized protocol for data collection."
Reasoning: The authors discuss limitations of the retrospective study designs and potential biases.
[Yes]
P26
Quote: "In summary, our data suggest that LAP reduction of intussusception is as technically feasible, safe, and efficacious as the open approach and may even be beneficial in shortening LOS. Future directions for study should include multicenter prospective studies. We are hopeful that the results of this study will encourage further investigation in this regard."
Reasoning: The authors provide a general interpretation and implications for future research.
[Yes]
P27
Quote: "No competing financial interests exist."
Reasoning: The authors provide a disclosure statement on funding and conflicts of interest for the systematic review itself, but not for the individual included studies.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
0
|
NA
|
NA
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
0
|
0
|
1
|
0
|
0
|
0
|
0
|
1
|
1
|
0
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
1
|
1
|
0
|
NA
|
NA
|
NA
|
NA
|
0
|
0
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
NA
|
NA
|
0
|
1
|
0
|
0
|
NA
|
NA
|
NA
|
0
|
1
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
1
|
0
|
1
|
0
|
0
|
1
|
0
|
0
|
NA
|
NA
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
0
|
1
|
0
|
0
|
1
|
1
|
1
|
NA
|
0
|
0
|
LLM response
20 quote(s) from
publication full text (mean similarity 97.9%)
A1
Quote: "In this review, we aim to elucidate the aspects of LESS for major urologic procedures in the pediatric population."
Reasoning: The research question and inclusion criteria were established before conducting the review.
[Yes]
A2
Quotes: "A comprehensive electronic search of Medline and Scopus databases was performed with the following keywords: "Single AND (trocar OR incision OR Site) AND Surgery AND (child* OR infant* OR pediatr* OR paediatr* OR adolescen*) NOT adult". Inclusion criteria for studies investigating the technical aspects and clinical outcomes of partial nephrectomies, nephroureterectomies, pyeloplasties in children. Data on parameters such as operation time, instrumentation, perioperative complications, hospital stay and follow up period were collected and further analyzed cumulatively."
Reasoning: At least two databases were searched and key words are provided, but a full search strategy is not available.
[No]
A3
Quotes: "A comprehensive electronic search of Medline and Scopus databases was performed with the following keywords: "Single AND (trocar OR incision OR Site) AND Surgery AND (child* OR infant* OR pediatr* OR paediatr* OR adolescen*) NOT adult". Inclusion criteria for studies investigating the technical aspects and clinical outcomes of partial nephrectomies, nephroureterectomies, pyeloplasties in children. Data on parameters such as operation time, instrumentation, perioperative complications, hospital stay and follow up period were collected and further analyzed cumulatively."
Reasoning: Medline and Scopus databases were searched, which counts as a comprehensive literature search.
[Yes]
A4
Reasoning: The authors do not mention searching for grey literature or including studies regardless of publication type.
[No]
A5
Quote: "In total 29 studies met the inclusion criteria; these included data from 54 patients who underwent partial nephrectomy/nephroureterectomy, 165 and 19 patients who underwent transperitoneal and retroperitoneal nephrectomy/nephroureterectomy respectively, 91 patients who underwent pyeloplasty and 57 patients who underwent varicocelectomy."
Reasoning: The number of included studies is provided, but a list of excluded studies is not given.
[No]
A6
Quotes: "Twenty nine studies met the inclusion criteria incorporating 386 patients who underwent 401 procedures. There were no major intraoperative complications, with only 19 patients (4.73%) facing postoperative complications. No perioperative deaths were reported."
"For the partial nephrectomy group (Table 1), 55 procedures were performed in 54 patients aged from 0.42 to 16.4 years (weighted mean: 1.29 years from 50 patients) [12-17]. Total operation time, ranged from 55 to 400 min (weighted mean: 132.05 min from 55 procedures). All procedures were performed transperitoneally and no intraoperative complications were noted. For 51 procedures (92.7%) a commercially available single-port device was employed."
Reasoning: Aggregated data on the number of patients, their age ranges, and outcomes are provided for the included studies.
[Yes]
A7
Quotes: "Assessment of the methodological quality of the study was assessed using the Newcastle-Ottawa Quality Assessment Scale (NOS) or non-randomized studies."
"From each eligible study the following parameters were extracted and tabulated: author, year, number of patients (author, date of publication), patient demographics (age and gender), procedure performed, indication, site of incision, details of surgical technique (entry device employed, access route, size of incision, laparoscopic instruments used, total operation time), intraoperative complications (including conversion to open surgery, use of additional ports and estimated blood loss (EBL)) and surgical outcome (length of hospital stay and post-operative complications)."
Reasoning: The Newcastle-Ottawa Scale was used to assess study quality. Relevant quality items like surgical technique, complications, and outcomes were also extracted.
[Yes]
A8
Quote: "In the hands of experienced surgeons LESS seems a feasible, efficient and less invasive alternative to standard laparoscopy in the field of pediatric urology. There is an eminent need of well-designed randomized controlled trials comparing the two techniques."
Reasoning: The authors acknowledge the need for well-designed RCTs, taking into account the limited methodological quality of included studies.
[Yes]
A9
Reasoning: This systematic review did not conduct a meta-analysis or combine study findings quantitatively.
[NA]
A10
Reasoning: The likelihood of publication bias was not assessed.
[No]
A11
Reasoning: Sources of funding and conflicts of interest are not reported for the included studies.
[No]
P1
Quote: "Laparoendoscopic single-site surgery (LESS) for major urological procedures in the pediatric population: A systematic review"
Reasoning: The title identifies the article as a systematic review.
[Yes]
P2
Quote: "Background: Improvements in laparoscopic surgery have led to the introduction of laparoendoscopic single-site surgery (LESS) as an alternative to conventional laparoscopy conferring a number of possible advantages. In this review, we aim to elucidate the aspects of LESS for major urologic procedures in the pediatric population.
Materials and methods: An in-depth search of the literature was performed in the databases of PubMed and Scopus, for studies investigating the technical aspects and clinical outcomes of partial nephrectomies, nephroureterectomies, pyeloplasties in children. Data on parameters such as operation time, instrumentation, perioperative complications, hospital stay and follow up period were collected and further analyzed cumulatively.
Results: Twenty nine studies met the inclusion criteria incorporating 386 patients who underwent 401 procedures. There were no major intraoperative complications, with only 19 patients (4.73%) facing postoperative complications. No perioperative deaths were reported.
Conclusions: In the hands of experienced surgeons LESS seems a feasible, efficient and less invasive alternative to standard laparoscopy in the field of pediatric urology. There is an eminent need of well-designed randomized controlled trials comparing the two techniques."
Reasoning: The abstract provides a structured summary including background, methods, results and conclusions.
[Yes]
P3
Quote: "Laparoscopic surgery is currently the gold standard for the surgical management of pediatric urologic pathologies [1]. Recent improvements in laparoscopic surgical techniques have led to the introduction of laparoendoscopic single-site surgery (LESS), a novel alternative to conventional laparoscopy (CL) conferring a number of possible advantages: better esthetic outcome, decreased incidence of port-site complications, less postoperative pain, reduced analgesic requirements and faster recovery [2]."
Reasoning: The introduction describes the rationale for the review in the context of recent developments in laparoscopic surgery.
[Yes]
P4
Quote: "In this review, we aim to elucidate the aspects of LESS for major urologic procedures in the pediatric population."
Reasoning: The objective is explicitly stated, but does not mention all PICOS elements.
[No]
P5
Reasoning: The article does not mention a protocol or registration number.
[No]
P6
Quote: "Inclusion criteria for studies investigating the technical aspects and clinical outcomes of partial nephrectomies, nephroureterectomies, pyeloplasties in children. Data on parameters such as operation time, instrumentation, perioperative complications, hospital stay and follow up period were collected and further analyzed cumulatively."
Reasoning: The inclusion criteria are described in terms of PICOS elements.
[Yes]
P7
Quote: "A comprehensive electronic search of Medline and Scopus databases was performed with the following keywords:"
Reasoning: Medline and Scopus databases are mentioned as information sources, but the date last searched is not provided.
[No]
P8
Reasoning: The full search strategy is not presented for any database.
[No]
P9
Quote: "In total 29 studies met the inclusion criteria; these included data from 54 patients who underwent partial nephrectomy/nephroureterectomy, 165 and 19 patients who underwent transperitoneal and retroperitoneal nephrectomy/nephroureterectomy respectively, 91 patients who underwent pyeloplasty and 57 patients who underwent varicocelectomy."
Reasoning: The number of included studies is provided, but the selection process is not described in detail.
[No]
P10
Quote: "From each eligible study the following parameters were extracted and tabulated: author, year, number of patients (author, date of publication), patient demographics (age and gender), procedure performed, indication, site of incision, details of surgical technique (entry device employed, access route, size of incision, laparoscopic instruments used, total operation time), intraoperative complications (including conversion to open surgery, use of additional ports and estimated blood loss (EBL)) and surgical outcome (length of hospital stay and post-operative complications)."
Reasoning: The data extraction method is described, but it is not specified if it was done in duplicate.
[No]
P11
Quote: "From each eligible study the following parameters were extracted and tabulated: author, year, number of patients (author, date of publication), patient demographics (age and gender), procedure performed, indication, site of incision, details of surgical technique (entry device employed, access route, size of incision, laparoscopic instruments used, total operation time), intraoperative complications (including conversion to open surgery, use of additional ports and estimated blood loss (EBL)) and surgical outcome (length of hospital stay and post-operative complications)."
Reasoning: The data items extracted are listed.
[Yes]
P12
Quote: "Assessment of the methodological quality of the study was assessed using the Newcastle-Ottawa Quality Assessment Scale (NOS) or non-randomized studies."
Reasoning: The Newcastle-Ottawa Scale was used to assess risk of bias in individual studies.
[Yes]
P13
Reasoning: The article does not mention any principal summary measures.
[No]
P14
Reasoning: No meta-analysis was performed in this systematic review.
[NA]
P15
Reasoning: Risk of bias across studies was not assessed.
[NA]
P16
Reasoning: No additional analyses were mentioned.
[NA]
P17
Quote: "In total 29 studies met the inclusion criteria; these included data from 54 patients who underwent partial nephrectomy/nephroureterectomy, 165 and 19 patients who underwent transperitoneal and retroperitoneal nephrectomy/nephroureterectomy respectively, 91 patients who underwent pyeloplasty and 57 patients who underwent varicocelectomy."
Reasoning: The number of included studies and patients is provided, but a flow diagram is not included and reasons for exclusions at each stage are not given.
[No]
P18
Quotes: "For the partial nephrectomy group (Table 1), 55 procedures were performed in 54 patients aged from 0.42 to 16.4 years (weighted mean: 1.29 years from 50 patients) [12-17]. Total operation time, ranged from 55 to 400 min (weighted mean: 132.05 min from 55 procedures). All procedures were performed transperitoneally and no intraoperative complications were noted. For 51 procedures (92.7%) a commercially available single-port device was employed."
Reasoning: Study characteristics like number of patients, age, procedure, and outcomes are presented for each included study.
[Yes]
P19
Quote: "Assessment of the methodological quality of the study was assessed using the Newcastle-Ottawa Quality Assessment Scale (NOS) or non-randomized studies."
Reasoning: The Newcastle-Ottawa Scale was used to assess risk of bias, but the risk of bias data for each study is not presented.
[No]
P20
Reasoning: Simple summary data and effect estimates are not provided for each study and outcome.
[No]
P21
Reasoning: No meta-analysis was conducted.
[NA]
P22
Reasoning: Risk of bias across studies was not assessed.
[NA]
P23
Reasoning: No additional analyses were reported.
[NA]
P24
Quote: "Twenty nine studies met the inclusion criteria incorporating 386 patients who underwent 401 procedures. There were no major intraoperative complications, with only 19 patients (4.73%) facing postoperative complications. No perioperative deaths were reported."
Reasoning: The main findings are summarized, but the strength of evidence for each outcome is not provided.
[No]
P25
Quote: "In the hands of experienced surgeons LESS seems a feasible, efficient and less invasive alternative to standard laparoscopy in the field of pediatric urology. There is an eminent need of well-designed randomized controlled trials comparing the two techniques."
Reasoning: Limitations of the evidence are acknowledged and the need for RCTs is highlighted.
[Yes]
P26
Quote: "In the hands of experienced surgeons LESS seems a feasible, efficient and less invasive alternative to standard laparoscopy in the field of pediatric urology. There is an eminent need of well-designed randomized controlled trials comparing the two techniques."
Reasoning: The results are interpreted in the context of the need for further research.
[Yes]
P27
Reasoning: Sources of funding for the systematic review are not described.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
NA
|
NA
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
0
|
1
|
1
|
0
|
0
|
0
|
0
|
1
|
0
|
0
|
1
|
0
|
1
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
1
|
1
|
1
|
NA
|
NA
|
NA
|
NA
|
1
|
0
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
NA
|
1
|
1
|
1
|
0
|
1
|
0
|
NA
|
1
|
1
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
1
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
NA
|
NA
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
0
|
LLM response
27 quote(s) from
publication full text (mean similarity 99.2%)
A1
"This review was performed according to a protocol that was designed a priori and recommended for systematic reviews and meta-analyses.16,17"
The authors state that the review was performed according to an a priori protocol.
[Yes]
A2
"Two authors reviewed all the citations independently. Agreement regarding potential relevance was reached by consensus. Full-text copies of potentially eligible papers were obtained, and the same 2 reviewers independently extracted data on study characteristics and outcomes of interest."
The authors state that two reviewers independently selected studies and extracted data, with consensus used to resolve disagreements.
[Yes]
A3
"Medline, Embase, Cinahl, and Cochrane databases were searched electronically on April 24, 2014, and then updated on May 11, 2015; the search was limited to reports published after January 1, 1980. One author and 2 librarians were involved in the search, and combinations of the relevant medical subject heading subject key words, and word variants for "isomerism," "heterotaxy," "situs ambiguous," "ivemark," and "malrotation" were used."
The authors searched multiple databases (Medline, Embase, Cinahl, Cochrane) and provided the search terms used. The search was supplemented by librarian involvement.
[Yes]
A4
No mention of including grey literature or unpublished studies.
[No]
A5
"Of those, full text of 50 articles were assessed with respect to their eligibility for inclusion (Figure 1), studies that were excluded are listed with their reasons for exclusion in Table I (available at www.jpeds.com). A total of 24 studies met inclusion criteria for the systematic review, which consisted of 1433 cases of heterotaxy."
The authors state that excluded studies are listed with reasons in Table I, which is available online as supplementary material.
[Yes]
A6
"The general characteristics of these studies are reported in Table II."
Table II provides aggregated data on the characteristics of the included studies, such as heterotaxy case numbers, incidence of IRA, screening rates, etc.
[Yes]
A7
"The quality of the 24 studies was judged as "low" in 8, "medium" in 10, and "high" in 6. The majority of the included studies showed an overall good rate with regard to the selection and outcome but not for the comparability."
The authors assessed the quality of included studies using the Newcastle-Ottawa Scale, with results reported.
[Yes]
A8
"The quality of the 24 studies was judged as "low" in 8, "medium" in 10, and "high" in 6. The majority of the included studies showed an overall good rate with regard to the selection and outcome but not for the comparability. The main weaknesses of these studies were their retrospective nature, small sample size, and lack of ascertainment of individual outcomes."
The authors considered study quality when interpreting the results, noting the main weaknesses were retrospective design, small sample sizes and lack of outcome ascertainment.
[Yes]
A9
"Between-study heterogeneity was explored graphically within the forest plot and assessed by the use of the I2 statistic, which represents the percentage between-study variation that is attributable to heterogeneity rather than chance.21 I2 of 0% indicates no observed heterogeneity, whereas I2 values of ≥50% indicate a substantial level of heterogeneity.22 We planned to use a fixed-effects model if substantial statistical heterogeneity was not present. Random-effects models also were used to test the robustness of results."
The authors assessed heterogeneity using I2 and planned to use a fixed effects model if no substantial heterogeneity was present, with random effects models used to test robustness.
[Yes]
A10
"Publication bias was explored statistically with the Begg and Mazumdar rank correlation test and Egger tests.23 When the number of individual studies was small, assessment of the potential publication bias would be problematic and strongly limited the reliability of formal tests."
The authors assessed publication bias using Begg's and Egger's tests, but note the assessment would be limited by the small number of studies.
[Yes]
A11
The authors declare no conflicts of interest.
No mention of assessing conflicts of interest or funding sources for the included studies.
[No]
P1
"Screening and Treatment of Intestinal Rotational Abnormalities in Heterotaxy: A Systematic Review and Meta-Analysis"
The title identifies the article as a systematic review and meta-analysis.
[Yes]
P2
The article has a structured abstract with labeled sections for Objective, Study Design, Results, and Conclusion. However, it is missing some recommended elements like methods, data sources, and registration number.
[No]
P3
"Heterotaxy is a congenital anomaly characterized by abnormal cardiovisceral left-to-right axis arrangement,1 with an incidence reported to be between 1 in 6000 to 1 in 20 000 live birth.2,3 According to the International Society for Nomenclature of Paediatric and Congenital Heart Disease, heterotaxy is a spectrum of disorders with many variations in the way internal organs are lateralized, being associated with many cardiac and extracardiac anomalies (eg, splenic anomalies, abdominal anatomy) or situs inversus (complete mirror-image of the intra-abdominal anatomy).1"
The introduction provides rationale for the review by describing what is known about heterotaxy and its incidence.
[Yes]
P4
"To assess the role of screening and prophylactic surgery for intestinal rotational abnormalities (IRAs) in asymptomatic patients with heterotaxy."
The introduction provides an explicit objective statement.
[Yes]
P5
"This review was performed according to a protocol that was designed a priori and recommended for systematic reviews and meta-analyses.16,17"
The authors indicate the review was performed according to an a priori protocol, but do not provide information on if/where it can be accessed or a registration number.
[No]
P6
No explicit mention of the detailed eligibility criteria used, such as PICOS and study characteristics.
[No]
P7
"Medline, Embase, Cinahl, and Cochrane databases were searched electronically on April 24, 2014, and then updated on May 11, 2015; the search was limited to reports published after January 1, 1980."
The authors list the databases searched and date ranges, but do not mention other information sources used.
[No]
P8
The authors mention the search terms used but do not provide the full search strategy for any database.
[No]
P9
"Two authors reviewed all the citations independently. Agreement regarding potential relevance was reached by consensus. Full-text copies of potentially eligible papers were obtained, and the same 2 reviewers independently extracted data on study characteristics and outcomes of interest."
The authors describe the process for selecting studies, including independent review and consensus.
[Yes]
P10
"Two authors reviewed all the citations independently. Agreement regarding potential relevance was reached by consensus. Full-text copies of potentially eligible papers were obtained, and the same 2 reviewers independently extracted data on study characteristics and outcomes of interest."
The authors state that two reviewers independently extracted data, but do not provide details on the method used.
[No]
P11
No list of all data items sought is provided.
[No]
P12
"The quality assessment of the included studies, performed by use of the NOS for cohort and case-control studies, is shown in Table III (available at www.jpeds. com).6,37,38,39,40,41,42"
The authors assessed risk of bias in individual studies using the Newcastle-Ottawa Scale.
[Yes]
P13
The authors do not explicitly state the principal summary measures.
[No]
P14
"Between-study heterogeneity was explored graphically within the forest plot and assessed by the use of the I2 statistic, which represents the percentage between-study variation that is attributable to heterogeneity rather than chance.21 I2 of 0% indicates no observed heterogeneity, whereas I2 values of ≥50% indicate a substantial level of heterogeneity.22 We planned to use a fixed-effects model if substantial statistical heterogeneity was not present. Random-effects models also were used to test the robustness of results."
The authors describe assessing heterogeneity using I2 and the methods used for meta-analysis.
[Yes]
P15
"Publication bias was explored statistically with the Begg and Mazumdar rank correlation test and Egger tests.23 When the number of individual studies was small, assessment of the potential publication bias would be problematic and strongly limited the reliability of formal tests."
The authors assessed publication bias using Begg's and Egger's tests.
[Yes]
P16
No additional analyses are mentioned.
[NA]
P17
"Of those, full text of 50 articles were assessed with respect to their eligibility for inclusion (Figure 1), studies that were excluded are listed with their reasons for exclusion in Table I (available at www.jpeds.com). A total of 24 studies met inclusion criteria for the systematic review, which consisted of 1433 cases of heterotaxy."
Figure 1 provides a flow diagram with the numbers of studies screened, assessed for eligibility, included and excluded with reasons.
[Yes]
P18
"The general characteristics of these studies are reported in Table II."
Table II provides the characteristics of the included studies with citations.
[Yes]
P19
"The quality assessment of the included studies, performed by use of the NOS for cohort and case-control studies, is shown in Table III (available at www.jpeds. com).6,37,38,39,40,41,42"
Table III shows the quality assessment results for each included study.
[Yes]
P20
The results for individual studies are not presented. The forest plots (Figures 2-5) show the pooled results only.
[No]
P21
The forest plots in Figures 2-5 show the meta-analysis results with confidence intervals and measures of consistency (I2).
[Yes]
P22
"Publication bias was explored statistically with the Begg and Mazumdar rank correlation test and Egger tests.23"
Publication bias was assessed but the results are not presented.
[No]
P23
No additional analyses were mentioned.
[NA]
P24
"The overall morbidity and mortality associated with screening and prophylactic surgery for asymptomatic IRA in heterotaxy is based on the balance between risks and benefits involved. Further data are needed to define true incidence of IRA and to be able to risk stratify this poorly homogenous population with heterotaxy."
The discussion summarizes the main findings and their relevance to key groups.
[Yes]
P25
"This meta-analysis is limited inherently by the quality of the published papers. The selected studies consisted of disparate populations of varied study period with patients treated as far back as 1968, making it impossible to eliminate temporal biases related to cardiac and overall survival. Various cohorts from different studies underwent variable periods of follow-up, hence the time for patients to develop symptoms related to IRA (including midgut volvulus) and complications after Ladd procedure are difficult to be compared. We also found that subjects described in many previous studies were heterogeneous; the most important variable was the presence of right vs left atrial isomerism, with the former bearing a greater rate of overall mortality (39%-79% compared with 12%-44% as reported in one study7) because of more complex congenital cardiac defects."
The authors discuss several limitations of the review, including quality of the included studies, disparate populations, variable follow-up, and heterogeneity.
[Yes]
P26
"To fully elucidate the benefits and risks of prophylactic surgery, a randomized controlled trial is required, along with follow-up regimen to determine their short- and longterm outcomes. The end points should include midgut volvulus, complications related to surgery, and mortality. This will then enable the natural history of IRA in heterotaxy to be better characterized, and its treatment to be fully established."
The authors provide a general interpretation and implications for future research.
[Yes]
P27
The authors declare no conflicts of interest.
No other mention of funding sources is provided.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
0
|
0
|
1
|
1
|
0
|
1
|
1
|
0
|
0
|
1
|
0
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
0
|
1
|
1
|
1
|
0
|
1
|
0
|
NA
|
1
|
1
|
1
|
1
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
0
|
0
|
0
|
1
|
1
|
1
|
1
|
0
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
0
|
0
|
LLM response
38 quote(s) from
publication full text (mean similarity 99.8%)
A1
Quote: "We conducted a systematic review and meta-analysis of the effectiveness of endoscopic surgery (ES) for neonatal CDH."
Reasoning: The research question and inclusion criteria were established before conducting the review.
[Yes]
A2
Quotes: "Two individual authors extracted data from each selected study." "Disagreements were resolved by discussion."
Reasoning: At least two independent authors extracted data and a consensus procedure was in place.
[Yes]
A3
Quotes: "Systematic searches of English-language articles were conducted by using MEDLINE and the Cochrane Library, including all records dated from their first entries to March 2015." "The articles were screened according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow chart (Fig. 1)."
Reasoning: At least two databases were searched and the search was supplemented by screening according to PRISMA.
[Yes]
A4
Quote: "When searching MEDLINE, we used the term "congenital diaphragmatic hernia," as well as terms related to surgical methods, including "laparotomy," "transabdomi*," "abdomi*," "thoracotomy," "transthoracic*," "open," "laparoscop*," "thoracoscop*," "minimally invasive," and "minimal access.""
Reasoning: The authors searched for reports regardless of publication type by using a variety of relevant terms.
[Yes]
A5
Quote: "Of 264 search results, 226 studies were excluded based on titles and abstracts. After screening the remaining 38 studies based on their full texts, 14 studies were included in the qualitative synthesis [8–21]."
Reasoning: The number of included and excluded studies at each stage was provided.
[Yes]
A6
Quote: "The characteristics of the included studies are presented in Table 1."
Reasoning: The characteristics of the included studies were provided in an aggregated table.
[Yes]
A7
Quote: "As assessed on the GRADE scale, the quality of evidence was very low for all outcomes (Fig. 2)."
Reasoning: The scientific quality of the included studies was assessed using the GRADE scale.
[Yes]
A8
Quote: "Although the evidence was insufficient, ES was clearly associated with more recurrence than was OS. Therefore, ES should not be the routine treatment for every neonate. It is crucially important to select suitable cases for ES."
Reasoning: The results of the quality assessment were considered when formulating the conclusions.
[Yes]
A9
Quotes: "No heterogeneity was observed among the included studies (τ2 = 0.00, χ2 = 1.32, γ = 5, p = 0.93; I2 = 0 %)." "The incidence of overall mortality was higher in the OS group than in the ES group (RR = 0.18; 95 % CI 0.09–0.38; z = 4.48; p < 0.00001; Fig. 3)."
Reasoning: Heterogeneity was assessed and appropriate methods were used to combine the findings.
[Yes]
A10
Quote: "There was also substantial imprecision because of the broad confidence intervals in all studies, except for the database study [19]."
Reasoning: The likelihood of publication bias was not assessed.
[No]
A11
Quotes: "This work was supported by a grant from the Ministry of Health, Labour and Welfare of Japan (Health and Labour Sciences Research Grants for Research on Intractable Diseases)." "The authors declare that they have no conflict of interest."
Reasoning: Sources of support were acknowledged for the systematic review but not for each included study.
[No]
P1
Quote: "Surgical approaches for neonatal congenital diaphragmatic hernia: a systematic review and meta-analysis"
Reasoning: The title identifies the report as a systematic review and meta-analysis.
[Yes]
P2
Quote: See the structured abstract on the first page.
Reasoning: A structured abstract is provided with labeled sections for background, methods, results, and conclusion.
[Yes]
P3
Quote: "Congenital diaphragmatic hernia (CDH) is a malformation characterized by a defect of the posterolateral diaphragm, intrathoracic herniation of abdominal viscera, and varying degrees of pulmonary hypoplasia and pulmonary hypertension [1]."
Reasoning: The rationale for the review is described in the context of what is known about CDH.
[Yes]
P4
Quote: "Purpose The optimal surgical approach for neonatal congenital diaphragmatic hernia (CDH) remains unclear. We conducted a systematic review and meta-analysis of the effectiveness of endoscopic surgery (ES) for neonatal CDH."
Reasoning: An explicit statement of the review question is provided referencing the PICO elements.
[Yes]
P5
The systematic review does not mention a protocol or registration number.
[No]
P6
Quote: "To be included in this meta-analysis, each study had to fulfill the following criteria: (1) the article type was not a review, case report, or letter; (2) all candidates were neonates; and (3) ES and OS were compared. ES included laparoscopic and thoracoscopic surgery, while OS included open abdominal surgery and open chest surgery."
Reasoning: The eligibility criteria are specified.
[Yes]
P7
Quote: "Systematic searches of English-language articles were conducted by using MEDLINE and the Cochrane Library, including all records dated from their first entries to March 2015."
Reasoning: The information sources and dates searched are described.
[Yes]
P8
Quote: "When searching MEDLINE, we used the term "congenital diaphragmatic hernia," as well as terms related to surgical methods, including "laparotomy," "transabdomi*," "abdomi*," "thoracotomy," "transthoracic*," "open," "laparoscop*," "thoracoscop*," "minimally invasive," and "minimal access.""
Reasoning: The full search strategy for MEDLINE is provided.
[Yes]
P9
Quote: "The articles were screened according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow chart (Fig. 1)."
Reasoning: The study selection process is described and depicted in a PRISMA flow diagram.
[Yes]
P10
Quote: "Two individual authors extracted data from each selected study. The following items were collected: (1) authors' names and year of publication, (2) title of the published study, (3) journal in which the study was published, (4) country and year of the study, (5) whether the study was single-center or multicenter, (6) whether the study had a prospective or retrospective design, (7) testing sample size, (8) patient age, (9) whether consecutive patients were included, (10) surgical approaches in both arms of the trial, (11) method of assigning patients to the two groups, (12) number of patients receiving each surgical approach, (13) number of patients who failed the allocated treatment (conversion to OS), (14) postoperative follow-up period, (15) number of postoperative deaths, and (16) number of patients who developed recurrence. After completing the data abstraction, disagreements were resolved by discussion."
Reasoning: The data collection process is described in detail.
[Yes]
P11
Quote: "The following items were collected: (1) authors' names and year of publication, (2) title of the published study, (3) journal in which the study was published, (4) country and year of the study, (5) whether the study was single-center or multicenter, (6) whether the study had a prospective or retrospective design, (7) testing sample size, (8) patient age, (9) whether consecutive patients were included, (10) surgical approaches in both arms of the trial, (11) method of assigning patients to the two groups, (12) number of patients receiving each surgical approach, (13) number of patients who failed the allocated treatment (conversion to OS), (14) postoperative follow-up period, (15) number of postoperative deaths, and (16) number of patients who developed recurrence."
Reasoning: All variables for which data were sought are listed.
[Yes]
P12
Quote: "As assessed on the GRADE scale, the quality of evidence was very low for all outcomes (Fig. 2). There was very serious risk of bias due to inappropriate patient selection, unequal follow-up durations, and the absence of controlling for confounding. Particularly, selection bias cannot to be ignored; patients who underwent ES were selected by their surgeons or according to facility criteria in six of the studies [16–21]."
Reasoning: The GRADE approach was used to assess risk of bias in individual studies.
[Yes]
P13
Quote: "Risk ratios (RRs) and 95 % confidential intervals (CIs) were determined using RevMan 5.3 software, which is provided by the Cochrane Collaboration (http://tech.cochrane.org/revman/download; Oxford, England)."
Reasoning: The principal summary measures (risk ratios and 95% CIs) are stated.
[Yes]
P14
Quote: "The random-effects model was used to estimate the combined outcomes [5]."
Reasoning: The methods of combining results are described.
[Yes]
P15
Quote: "There was also substantial imprecision because of the broad confidence intervals in all studies, except for the database study [19]."
Reasoning: Imprecision, a form of bias across studies, was assessed.
[Yes]
P16
The systematic review does not describe any additional analyses.
[No]
P17
Quote: "Of 264 search results, 226 studies were excluded based on titles and abstracts. After screening the remaining 38 studies based on their full texts, 14 studies were included in the qualitative synthesis [8–21]. Furthermore, eight observational studies [14–21] published between 2009 and 2013 were included in the quantitative synthesis (Fig. 1)."
Reasoning: The numbers of studies screened, assessed for eligibility, and included are provided, with reasons for exclusions, in a PRISMA flow diagram.
[Yes]
P18
Quote: "The characteristics of the included studies are presented in Table 1."
Reasoning: The characteristics of each included study are presented in Table 1 along with citations.
[Yes]
P19
Quote: "As assessed on the GRADE scale, the quality of evidence was very low for all outcomes (Fig. 2)."
Reasoning: The risk of bias assessments for each study are presented in Figure 2.
[Yes]
P20
The results for individual studies are not presented.
[No]
P21
Quotes: "The incidence of overall mortality was higher in the OS group than in the ES group (RR = 0.18; 95 % CI 0.09–0.38; z = 4.48; p < 0.00001; Fig. 3)." "The recurrence rate in the ES group could have been underestimated. The presumed advantages of ES for CDH are good cosmetics for the wounds, as well as reduced intra- and post-operative surgical stresses. Early recovery from surgical stresses often reduces the duration of postoperative mechanical ventilation and the overall length of stay [15]."
Reasoning: The results of the meta-analyses are presented with effect estimates and confidence intervals.
[Yes]
P22
The systematic review does not present any assessments of risk of bias across studies.
[No]
P23
The systematic review did not conduct any additional analyses.
[NA]
P24
Quote: "In conclusion, evidence for the effectiveness of ES in CDH neonates remains insufficient. As derived in the present study, the best available evidence showed that ES had an unclear effect on mortality in neonatal CDH, and that the recurrence rate in the ES group was clearly higher than that in the OS group. Therefore, ES should not be the routine treatment for every neonate. It is crucially important to select suitable cases for ES, but the criteria for selection remain a topic for future discussion."
Reasoning: The main findings are summarized, including the strength of evidence and relevance to key groups.
[Yes]
P25
Quote: "Although the use of a patch seemed to be a risk factor for recurrence in ES, patch use is difficult to predict. In actuality, the rates of patch use among operative cases were 51.0 % in CDHSG [19] and 37.8 % in the Japanese CDH Study Group [24]. To establish definitive criteria for ES, further studies are needed."
Reasoning: Limitations at the study and review level are discussed.
[Yes]
P26
Quote: "In conclusion, evidence for the effectiveness of ES in CDH neonates remains insufficient. As derived in the present study, the best available evidence showed that ES had an unclear effect on mortality in neonatal CDH, and that the recurrence rate in the ES group was clearly higher than that in the OS group. Therefore, ES should not be the routine treatment for every neonate. It is crucially important to select suitable cases for ES, but the criteria for selection remain a topic for future discussion."
Reasoning: A general interpretation of the results and implications for future research are provided.
[Yes]
P27
Quote: "This work was supported by a grant from the Ministry of Health, Labour and Welfare of Japan (Health and Labour Sciences Research Grants for Research on Intractable Diseases)."
Reasoning: The source of funding for the systematic review is described.
[Yes]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
1
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
0
|
0
|
1
|
1
|
1
|
1
|
1
|
0
|
0
|
1
|
1
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
NA
|
NA
|
1
|
1
|
1
|
1
|
1
|
NA
|
NA
|
1
|
1
|
1
|
1
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
1
|
1
|
0
|
0
|
0
|
1
|
1
|
1
|
1
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
0
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
NA
|
0
|
LLM response
26 quote(s) from
publication full text (mean similarity 97%)
A1
"A study protocol outlining the search strategy, outcomes, and methods of data extraction and statistical analysis was designed and prospectively registered with the Prospero database (CRD42013005698)."
The authors mention that a study protocol was registered prospectively with PROSPERO.
[Yes]
A2
No relevant quotes found.
The authors do not mention whether study selection and data extraction were performed in duplicate.
[No]
A3
"We designed all publications from 1 January 1998 to 1 January 2014 from EMBASE, MEDLINE and Cochrane library databases using the search strategy detailed in online supplementary appendix I."
The authors searched multiple databases (EMBASE, MEDLINE, Cochrane) and provided the search strategy in an online appendix.
[Yes]
A4
No relevant quotes found.
The authors do not mention whether they searched for grey literature or unpublished studies.
[No]
A5
"Full text articles excluded: No comparative arm (31) Data unavailable for laparoscopic abdominal approach (1) Posterior sagittal approach to transanal anastomosis (2) Laparoscopic Duhamel-type anastomosis (1) Planned multi-stage procedure (1)"
The authors provide a list of excluded studies with reasons.
[Yes]
A6
"Four hundred and five patients were included in the meta-analysis; 159 underwent a LAPT and 248 underwent a TTERPT. Table 2 summarises the characteristics of included studies. All five studies used a Soave-type endorectal dissection; however, no studies reported in detail the length of muscular cuff used."
The authors provide aggregate characteristics of included studies in Table 2.
[Yes]
A7
"Two independent authors (DT and BA) assessed study quality using the Newcastle-Ottawa Scale for case-control and cohort studies."
The authors assessed study quality using the Newcastle-Ottawa Scale.
[Yes]
A8
"The only significant difference between procedures was a shorter operating time with totally transanal endorectal pull-through. Incidence of serious postoperative complications, including enterocolitis, faecal incontinence and chronic constipation, did not differ between the two procedures."
The authors consider study quality when interpreting the results and drawing conclusions.
[Yes]
A9
"Continuous data were analysed using an inverse variance model to produce a mean difference. Dichotomous variables were analysed using a Mantel-Haenszel model to produce ORs. χ2 Test for heterogeneity was used to assess agreement within studies. Random-effects models were used when there was significant variation in outcome assessment measures between studies or when there was evidence of significant heterogeneity; otherwise, fixed-effects models were used."
The authors used appropriate methods to combine findings, assessing and accounting for heterogeneity.
[Yes]
A10
No relevant quotes found.
The authors do not mention assessing publication bias.
[NA] - Not applicable since this is a systematic review without a meta-analysis.
A11
"Funding MK is funded by a National Institute for Health Research Professorship."
The authors report the funding source for the systematic review. However, they do not report funding sources for each included study.
[No]
P1
"BMJ Open Laparoscopic assistance for primary transanal pull-through in Hirschsprung's disease: a systematic review and meta-analysis"
The title identifies the article as a systematic review and meta-analysis.
[Yes]
P2
The abstract is structured with labeled sections for Objective, Design, Setting, Participants, Interventions, Primary and secondary outcome measures, Results, and Conclusions.
The abstract is structured and contains most of the key elements. However, it is missing some details like data sources, study appraisal methods, and registration number.
[Yes]
P3
"Since the first description of Harald Hirschsprung's eponymous condition in 1889,1 there has been ongoing debate regarding the optimal surgical approach."
The introduction describes the rationale for the review in the context of the ongoing debate about surgical approaches for Hirschsprung's disease.
[Yes]
P4
"The aim of this study was to conduct a systematic review and meta-analysis to compare outcomes for infants with Hirschsprung's disease undergoing a TTERPT procedure with those undergoing a laparoscopically assisted transanal pull-through (LAPT)."
The introduction provides an explicit statement of the review question, referring to the PICO elements.
[Yes]
P5
"A study protocol outlining the search strategy, outcomes, and methods of data extraction and statistical analysis was designed and prospectively registered with the Prospero database (CRD42013005698)."
The authors indicate that a protocol was registered in PROSPERO and provide the registration number.
[Yes]
P6
"Titles and abstracts of potentially relevant papers were screened by two independent authors (DT and BA). The full texts of all identified studies were assessed against the criteria in table 1 by the two independent authors (DT and BA), and study reference lists were hand searched for potentially relevant studies."
The authors specify the study characteristics used as eligibility criteria and the process for screening and selecting studies.
[Yes]
P7
"We designed all publications from 1 January 1998 to 1 January 2014 from EMBASE, MEDLINE and Cochrane library databases using the search strategy detailed in online supplementary appendix I."
The authors describe the information sources searched, including the databases with dates of coverage and the date last searched.
[Yes]
P8
"We designed all publications from 1 January 1998 to 1 January 2014 from EMBASE, MEDLINE and Cochrane library databases using the search strategy detailed in online supplementary appendix I."
The authors mention that the full search strategy is provided in an online supplementary appendix.
[Yes]
P9
"Titles and abstracts of potentially relevant papers were screened by two independent authors (DT and BA). The full texts of all identified studies were assessed against the criteria in table 1 by the two independent authors (DT and BA), and study reference lists were hand searched for potentially relevant studies."
The authors state the process for selecting studies, including screening titles/abstracts, assessing full texts, and hand searching references.
[Yes]
P10
"Data were extracted by the two independent authors (DT and BA) using a predesigned proforma. Data were collected regarding: age at gestation, diagnosis and surgery, level of anal dissection, length of mucosal cuff, length and location of agangliosis, and any congenital abnormalities."
The authors describe the method of data extraction, using a predesigned form and two independent extractors.
[Yes]
P11
"Data were extracted by the two independent authors (DT and BA) using a predesigned proforma. Data were collected regarding: age at gestation, diagnosis and surgery, level of anal dissection, length of mucosal cuff, length and location of agangliosis, and any congenital abnormalities."
The authors list the data items sought, including participant, intervention, and outcome characteristics.
[Yes]
P12
"Two independent authors (DT and BA) assessed study quality using the Newcastle-Ottawa Scale for case-control and cohort studies."
The authors describe the method used to assess risk of bias in individual studies (Newcastle-Ottawa Scale).
[Yes]
P13
"Continuous data were analysed using an inverse variance model to produce a mean difference. Dichotomous variables were analysed using a Mantel-Haenszel model to produce ORs."
The authors state the principal summary measures (mean difference for continuous outcomes, odds ratio for dichotomous outcomes).
[Yes]
P14
"Continuous data were analysed using an inverse variance model to produce a mean difference. Dichotomous variables were analysed using a Mantel-Haenszel model to produce ORs. χ2 Test for heterogeneity was used to assess agreement within studies. Random-effects models were used when there was significant variation in outcome assessment measures between studies or when there was evidence of significant heterogeneity; otherwise, fixed-effects models were used."
The authors describe the methods used for meta-analysis, including the models used and how they handled heterogeneity.
[Yes]
P15
No relevant quotes found.
The authors do not mention any methods used to assess risk of bias that may affect the cumulative evidence, such as publication bias or selective reporting.
[NA] - Not applicable since this is a systematic review without a meta-analysis.
P16
No relevant quotes found.
The authors do not mention any additional analyses such as subgroup analyses or meta-regression.
[NA] - Not applicable since this is a systematic review without a meta-analysis.
P17
"A total of 2107 records were screened, of which 41 studies potentially met the eligibility criteria (figure 1). Thirty-one studies were excluded because there was no comparative study arm. Two were excluded because they used a posterior sagittal rather than a transanal approach.20 21 One study was excluded because it used a laparoscopic Duhamel-type anastomosis22 and one study because infants undergoing a staged procedure were pooled with primary procedure results.23 Data were sought from the authors that pooled transanal and abdominal and laparoscopic-assisted procedures.23 Data were available and generously provided by the authors of one of these studies.25 Four further retrospective observational studies were eligible for inclusion in the final review."
The authors provide the number of studies screened, assessed for eligibility, and included, with reasons for exclusions at each stage. They also include a PRISMA flow diagram (Figure 1).
[Yes]
P18
"Four hundred and five patients were included in the meta-analysis; 159 underwent a LAPT and 248 underwent a TTERPT. Table 2 summarises the characteristics of included studies."
The authors present the characteristics of included studies in an aggregate form (Table 2) and provide citations.
[Yes]
P19
"Two independent authors (DT and BA) assessed study quality using the Newcastle-Ottawa Scale for case-control and cohort studies. Scores were low overall, with one study scoring 6/9, one scoring 5/9, one scoring 4/9 and two scoring 3/9."
The authors present the risk of bias assessments for each included study.
[Yes]
P20
The authors present individual study results in the forest plots in Figures 2-4, with effect estimates and confidence intervals for each outcome.
[Yes]
P21
The authors present the meta-analysis results, including pooled effect estimates, confidence intervals, and measures of consistency (I2) in the text and forest plots (Figures 2-4).
[Yes]
P22
No relevant quotes found.
The authors do not present any assessment of risk of bias across studies, such as publication bias or selective reporting.
[NA] - Not applicable since this is a systematic review without a meta-analysis.
P23
No relevant quotes found.
The authors do not report any additional analyses such as sensitivity analysis or subgroup analysis.
[NA] - Not applicable since this is a systematic review without a meta-analysis.
P24
"The only significant difference between procedures was a shorter operating time with totally transanal endorectal pull-through. Incidence of serious postoperative complications, including enterocolitis, faecal incontinence and chronic constipation, did not differ between the two procedures."
The authors summarize the main findings and their relevance in the Discussion section.
[Yes]
P25
"The main limitations of this study include limited statistical power as we identified only five eligible studies, the generally low quality of the studies, heterogeneity with respect to outcome assessment, and the limited long-term follow-up."
"This study identifies an urgent need for high-quality prospective studies and an absence of any data obtained using randomisation methods."
The authors discuss the limitations at the study/outcome level (heterogeneity, limited follow-up) and review level (limited number of low-quality studies, lack of randomized trials).
[Yes]
P26
"Despite widespread enthusiasm for newer procedures, it is important to note that virtually all data on bowel function in adulthood in patients with Hirschsprung's disease come from those operated on with a transabdominal Duhamel technique.32 Second, intention-to-treat analysis and reporting of comparative studies is vital, particularly in relation to the need to perform a laparotomy in a planned totally transanal procedure due to an unidentified long segment or total colonic aganglionosis. It is essential that authors accurately report such events, so that the true incidence of these occurrences can be gauged."
The authors provide a general interpretation of the results in the context of the long-term data from older techniques and the need for intention-to-treat analysis in future studies.
[Yes]
P27
"Funding MK is funded by a National Institute for Health Research Professorship."
The authors describe the source of funding for the systematic review.
[Yes]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
1
|
1
|
1
|
0
|
NA
|
NA
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
0
|
1
|
1
|
0
|
0
|
0
|
0
|
1
|
1
|
0
|
0
|
NA
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
1
|
1
|
0
|
NA
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
0
|
1
|
1
|
0
|
0
|
NA
|
NA
|
0
|
1
|
1
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
0
|
0
|
0
|
1
|
0
|
0
|
NA
|
NA
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
0
|
0
|
0
|
0
|
1
|
0
|
NA
|
NA
|
NA
|
0
|
LLM response
19 quote(s) from
publication full text (mean similarity 100%)
A1
Quote: "We decided, a priori, to limit our review to studies that reported outcomes of balloon dilatation (both endoscopically and under fluoroscopic control) of anastomotic strictures secondary to surgical repair of oesophageal atresia in children."
Reasoning: The authors state that they decided on the research question and inclusion criteria a priori, before conducting the review.
[Yes]
A2
Quotes: No relevant quotes found.
Reasoning: The authors do not mention duplicate study selection and data extraction.
[No]
A3
Quotes: "We searched the standard databases (January, 1960–May, 2012): MEDLINE, EMBASE and Cochrane Library Controlled Trials Register (CENTRAL) using the MeSH Terms "esophageal stricture", "esophageal stenosis" and "balloon dilatation" to identify the studies."
Reasoning: At least 2 databases were searched along with MeSH terms, but no supplementary strategies were mentioned.
[No]
A4
Quotes: No relevant quotes found.
Reasoning: The inclusion of grey literature is not mentioned.
[No]
A5
Quotes: "We identified 26 studies from our search that were deemed relevant and these were further scrutinised for eligibility for inclusion in this review. Only five studies met the inclusion criteria; 21 studies were excluded for reasons outlined in the selection flow chart in Fig. 1."
Reasoning: A flow diagram of included and excluded studies is provided, but the excluded studies are not explicitly listed or referenced.
[No]
A6
Quote: "Table 1 Characteristics of studies included in the review"
Reasoning: Characteristics of the included studies are provided in an aggregated table.
[Yes]
A7
Quotes: No relevant quotes found.
Reasoning: The authors do not describe an a priori method for assessing the quality of included studies.
[No]
A8
Quotes: No relevant quotes found.
Reasoning: Not applicable as the scientific quality of included studies was not assessed.
[NA]
A9
Quotes: No relevant quotes found.
Reasoning: Not applicable as no meta-analysis was performed.
[NA]
A10
Quotes: No relevant quotes found.
Reasoning: Not applicable as no meta-analysis was performed.
[NA]
A11
Quotes: No relevant quotes found.
Reasoning: Conflicts of interest are not reported for the systematic review or the included studies.
[No]
P1
Quote: "Balloon dilatation of anastomotic strictures secondary to surgical repair of oesophageal atresia: a systematic review"
Reasoning: The title identifies the article as a systematic review.
[Yes]
P2
Quote: No structured abstract is provided.
Reasoning: The abstract is not structured with distinct labeled sections.
[No]
P3
Quote: "Benign oesophageal strictures in children may occur as a result of congenital anomalies or complications secondary to either caustic oesophageal reflux or surgical correction of oesophageal atresia. Anastomotic strictures occur in 18–30% of patients following surgery for oesophageal atresia [1]."
Reasoning: The introduction provides rationale for the review in the context of what is known about esophageal strictures in children.
[Yes]
P4
Quote: "The main advantage offered by balloon dilatation is the use of uniform axial forces to dilate the stricture in a radial manner, avoiding the abrupt shearing forces that are associated with bougiemage [5]. In this review, we sought to review the current published evidence of the outcomes of balloon dilatation of anastomotic strictures secondary to surgical repair of oesophageal atresia."
Reasoning: The introduction states the review question, mentioning the population, intervention and outcomes of interest.
[Yes]
P5
Quotes: No relevant quotes found.
Reasoning: No review protocol or registration is mentioned.
[No]
P6
Quote: "We followed the guidelines according to the preferred reporting items for systematic reviews and meta-analyses: the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement [7]."
Reasoning: The methods mention following PRISMA guidelines but do not explicitly state the eligibility criteria.
[No]
P7
Quote: "We searched the standard databases (January, 1960–May, 2012): MEDLINE, EMBASE and Cochrane Library Controlled Trials Register (CENTRAL) using the MeSH Terms "esophageal stricture", "esophageal stenosis" and "balloon dilatation" to identify the studies."
Reasoning: The databases searched are listed but the date last searched is not provided.
[No]
P8
Quotes: No relevant quotes found.
Reasoning: The full search strategy is not presented.
[No]
P9
Quote: "Two reviewers (M.T. and A.T.) independently abstracted data from all studies onto a predefined data collection form. Any discrepancies were resolved by consensus."
Reasoning: The study selection process is described.
[Yes]
P10
Quote: "Two reviewers (M.T. and A.T.) independently abstracted data from all studies onto a predefined data collection form. Any discrepancies were resolved by consensus."
Reasoning: The data collection process is described.
[Yes]
P11
Quotes: No relevant quotes found.
Reasoning: Data items are not defined.
[No]
P12
Quotes: No relevant quotes found.
Reasoning: Risk of bias assessment is not described.
[No]
P13
Quotes: No relevant quotes found.
Reasoning: Not applicable as no meta-analysis was performed.
[NA]
P14
Quotes: No relevant quotes found.
Reasoning: Not applicable as no meta-analysis was performed.
[NA]
P15
Quotes: No relevant quotes found.
Reasoning: Risk of bias across studies is not mentioned.
[No]
P16
Quotes: No relevant quotes found.
Reasoning: No additional analyses are mentioned.
[No]
P17
Quote: "We identified 26 studies from our search that were deemed relevant and these were further scrutinised for eligibility for inclusion in this review. Only five studies met the inclusion criteria; 21 studies were excluded for reasons outlined in the selection flow chart in Fig. 1."
Reasoning: A flow diagram is provided showing the number of studies screened, assessed for eligibility, included and excluded.
[Yes]
P18
Quote: "Table 1 Characteristics of studies included in the review"
Reasoning: Characteristics of included studies are provided in a table with citations.
[Yes]
P19
Quotes: No relevant quotes found.
Reasoning: Risk of bias of individual studies is not presented.
[No]
P20
Quote: "Table 3 Outcomes following dilatation"
Reasoning: Outcomes for each study are presented in a table but without effect estimates and confidence intervals.
[No]
P21
Quotes: No relevant quotes found.
Reasoning: Not applicable as no meta-analysis was performed.
[NA]
P22
Quotes: No relevant quotes found.
Reasoning: Not applicable as no meta-analysis was performed.
[NA]
P23
Quotes: No relevant quotes found.
Reasoning: No additional analyses are mentioned.
[No]
P24
Quote: "Balloon dilatation for anastomotic strictures post-oesophageal atresia repair is safe, and associated with a low perforation and mortality rates, and approximately three dilatations are required per child. The perforation rates are very low and most perforations are amenable to non-operative management."
Reasoning: The main findings are summarized in the conclusion.
[Yes]
P25
Quote: "One of the chief limitations present in all the studies in this review has been the lack of a standardised definition of success following balloon dilatation. One can argue that clinical success should be the "gold standard" definition as opposed to procedural success."
Reasoning: Some limitations of the review are discussed.
[Yes]
P26
Quote: "We would argue that combining radiologic/endoscopic success (achieving lumen diameters compatible with relief of obstruction) with clinical outcomes would provide a better index of the efficacy of balloon dilatation."
Reasoning: The conclusion provides some interpretation of the results and implications for future research.
[Yes]
P27
Quotes: No relevant quotes found.
Reasoning: Sources of funding are not described.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
NA
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
0
|
1
|
0
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
1
|
NA
|
NA
|
NA
|
NA
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
0
|
1
|
NA
|
NA
|
NA
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
1
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
1
|
1
|
1
|
1
|
1
|
NA
|
NA
|
NA
|
NA
|
NA
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
0
|
1
|
0
|
0
|
NA
|
NA
|
NA
|
NA
|
0
|
0
|
LLM response
22 quote(s) from
publication full text (mean similarity 99.5%)
2
quote(s) from the LLM prompt briefing (mean similarity 53.2%) -
were instructions quoted (ok) or examples (unwanted beahviour)?
A1. Was an 'a priori' design provided?
Quotes: "We searched the CENTRAL (The Cochrane Library 2014, Issue 1), MEDLINE/PubMed (from 1966 to February 2014) and EMBASE/Ovid (from 1980 to February 2014) to identify relevant studies."
Reasoning: The authors mention searching specific databases within a date range, indicating an a priori search strategy.
[Yes]
A2. Was there duplicate study selection and data extraction?
Quotes: "Two authors performed the study selection independently.", "Since no eligible studies were identified, data extraction by two independent authors using a standardised form could not be performed."
Reasoning: Study selection was done in duplicate, but data extraction could not be performed due to lack of eligible studies.
[No]
A3. Was a comprehensive literature search performed?
Quotes: "We searched CENTRAL (The Cochrane Library 2014, Issue 1), MEDLINE/PubMed (from 1966 to February 2014) and EMBASE/Ovid (from 1980 to February 2014). The search strategies for the different electronic databases (using a combination of controlled vocabulary and text word terms) are reported in the Appendices (Appendix 1; Appendix 2; Appendix 3)."
Reasoning: The authors searched multiple databases using a comprehensive search strategy.
[Yes]
A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion?
Quotes: No relevant quotes identified.
Reasoning: The authors do not mention including or excluding studies based on publication status.
[No]
A5. Was a list of studies (included and excluded) provided?
Quotes: "After screening the titles and abstracts we excluded 534 references which clearly did not meet the inclusion criteria. We assessed eight full text studies for eligibility and all of these studies were excluded from the review because they were not RCTs or CCTs. These excluded studies included case series, retrospective chart reviews and retrospective cohort studies."
Reasoning: The authors provide details on the number of excluded studies and reasons for exclusion, but do not provide a list of the excluded studies.
[No]
A6. Were the characteristics of the included studies provided?
Quotes: "Zero studies included in qualitative synthesis (meta-analysis)"
Reasoning: No studies were included in the review, so study characteristics could not be provided.
[NA]
A7. Was the scientific quality of the included studies assessed and documented?
Quotes: "Zero studies included in qualitative synthesis (meta-analysis)"
Reasoning: No studies were included in the review, so study quality assessment could not be performed.
[NA]
A8. Was the scientific quality of the included studies used appropriately in formulating conclusions?
Quotes: "Zero studies included in qualitative synthesis (meta-analysis)"
Reasoning: No studies were included in the review, so study quality could not be considered in the conclusions.
[NA]
A9. Were the methods used to combine the findings of studies appropriate?
Quotes: "Zero studies included in qualitative synthesis (meta-analysis)"
Reasoning: No studies were included in the review, so there was no quantitative synthesis performed.
[NA]
A10. Was the likelihood of publication bias assessed?
Quotes: No relevant quotes identified.
Reasoning: The authors do not mention assessing publication bias.
[No]
A11. Was the conflict of interest included?
Quotes: "None known." under "DECLARATIONS OF INTEREST"
Reasoning: The authors declare no conflicts of interest for the review, but do not report on conflicts of interest for any included studies.
[No]
P1. Title
Quotes: "Minimally invasive surgery versus open surgery for the treatment of solid abdominal and thoracic neoplasms in children (Review)"
Reasoning: The title identifies the article as a systematic review.
[Yes]
P2. Abstract / Structured summary
Quotes: The abstract is structured with labeled sections for Background, Objectives, Search methods, Selection criteria, Data collection and analysis, Main results, and Authors' conclusions.
Reasoning: The abstract is structured and includes the required elements.
[Yes]
P3. Introduction / Rationale
Quotes: "Minimally invasive surgery (MIS) is an accepted surgical technique for the treatment of a variety of benign diseases. After the introduction of laparoscopic cholecystectomy, other surgical procedures such as appendectomy, fundoplication, splenectomy and nephrectomy were soon performed using MIS (Bax 2005; Georgeson 2000; Georgeson 2003; Johnson 1997; Schaarschmidt 2005; Ure 2000). MIS showed short-term postoperative advantages compared to open surgery including less pain, a shorter duration of postoperative ileus and better pulmonary function, all leading to a more rapid recovery and shorter hospital stay (Bax 2005; Leung 2004; Milsom 1998)."
Reasoning: The authors provide rationale for the review by discussing the background and current state of knowledge on the topic.
[Yes]
P4. Introduction / Objectives
Quotes: "To ascertain differences in outcome between the minimally invasive and open surgical approaches for the treatment of solid intra-abdominal or intra-thoracic neoplasms in children. The primary outcomes of interest are OS, EFS, port-site metastases and recurrence rate; the secondary outcome of interest is surgical morbidity."
Reasoning: The objectives are explicitly stated and include the PICO elements.
[Yes]
P5. Methods / Protocol and registration
Quotes: No relevant quotes identified.
Reasoning: The authors do not mention a published protocol or registration number.
[No]
P6. Methods / Eligibility criteria
Quotes: "Types of studies: Randomised controlled trials (RCTs) or controlled clinical trials (CCTs) comparing minimally invasive surgery (MIS) and open surgery for the treatment of intra-thoracic or intra-abdominal solid neoplasms in children. Types of participants: Children (aged 0 to 18 years at diagnosis) with solid intra-thoracic or intra-abdominal neoplasms who were treated with MIS or open surgery (irrespective of previous therapy) were considered for inclusion."
Reasoning: The authors specify the study designs, participant characteristics, and interventions used as eligibility criteria.
[Yes]
P7. Methods / Information sources
Quotes: "We searched CENTRAL (The Cochrane Library 2014, Issue 1), MEDLINE/PubMed (from 1966 to February 2014) and EMBASE/Ovid (from 1980 to February 2014)."
Reasoning: The authors describe the electronic databases searched and the dates of coverage.
[Yes]
P8. Methods / Search
Quotes: "The search strategies for the different electronic databases (using a combination of controlled vocabulary and text word terms) are reported in the Appendices (Appendix 1; Appendix 2; Appendix 3)."
Reasoning: The full search strategies are provided in the appendices.
[Yes]
P9. Methods / Study selection
Quotes: "Two authors performed the study selection independently."
Reasoning: The process for selecting studies is described.
[Yes]
P10. Methods / Data collection process
Quotes: "Since no eligible studies were identified, data extraction by two independent authors using a standardised form could not be performed."
Reasoning: The planned data extraction process is described, though it could not be carried out due to lack of included studies.
[Yes]
P11. Methods / Data items
Quotes: No relevant quotes identified.
Reasoning: The authors do not provide a list of the variables for which data were sought.
[No]
P12. Methods / Risk of bias in individual studies
Quotes: "If eligible studies had been identified, two authors would have independently assessed the risk of bias in these studies according to the criteria of the Cochrane Childhood Cancer Group."
Reasoning: The authors describe the planned method for assessing risk of bias in individual studies, though it could not be carried out.
[Yes]
P13. Methods / Summary measures
Quotes: No relevant quotes identified.
Reasoning: The authors do not state the planned summary measures.
[No]
P14. Methods / Synthesis of results
Quotes: "Zero studies included in qualitative synthesis (meta-analysis)"
Reasoning: No studies were included, so no synthesis was performed.
[NA]
P15. Methods / Risk of bias across studies
Quotes: No relevant quotes identified.
Reasoning: The authors do not describe any planned methods for assessing risk of bias across studies.
[No]
P16. Methods / Additional analyses
Quotes: No relevant quotes identified.
Reasoning: The authors do not mention any additional analyses.
[No]
P17. Results / Study selection
Quotes: "After screening the titles and abstracts we excluded 534 references which clearly did not meet the inclusion criteria. We assessed eight full text studies for eligibility and all of these studies were excluded from the review because they were not RCTs or CCTs. These excluded studies included case series, retrospective chart reviews and retrospective cohort studies."
Reasoning: The authors provide details on the number of records screened and excluded at each stage, with reasons for exclusions.
[Yes]
P18. Results / Study characteristics
Quotes: "Zero studies included in qualitative synthesis (meta-analysis)"
Reasoning: No studies were included, so study characteristics could not be reported.
[NA]
P19. Results / Risk of bias within studies
Quotes: "Zero studies included in qualitative synthesis (meta-analysis)"
Reasoning: No studies were included, so within-study risk of bias could not be assessed.
[NA]
P20. Results / Results of individual studies
Quotes: "Zero studies included in qualitative synthesis (meta-analysis)"
Reasoning: No studies were included, so no individual study results could be reported.
[NA]
P21. Results / Synthesis of results
Quotes: "Zero studies included in qualitative synthesis (meta-analysis)"
Reasoning: No studies were included, so no synthesis was performed.
[NA]
P22. Results / Risk of bias across studies
Quotes: No relevant quotes identified.
Reasoning: The authors do not report assessing risk of bias across studies.
[NA]
P23. Results / Additional analysis
Quotes: No relevant quotes identified.
Reasoning: The authors do not report any additional analyses.
[NA]
P24. Discussion / Summary of evidence
Quotes: "No RCTs or CCTs evaluating MIS for the treatment of solid intra-thoracic or intra-abdominal neoplasms in children could be identified. The current evidence base informing the use of MIS in children with solid abdominal and thoracic neoplasms is based on other study designs like case reports, retrospective chart reviews and cohort studies and should be interpreted with caution."
Reasoning: The authors summarize the main finding of a lack of RCTs or CCTs on the topic.
[Yes]
P25. Discussion / Limitations
Quotes: "High quality RCTs comparing MIS to open surgery are required. These RCTs should be performed in homogeneous study populations (for example, with regard to tumour type and stage of disease). They should have a long-term follow up and the number of included patients should be sufficient to obtain the power needed for the results to be reliable. To obtain adequate numbers of patients, centres specialising in MIS in children should collaborate."
Reasoning: The authors discuss limitations at the review level, including the lack of RCTs and need for future high-quality trials.
[Yes]
P26. Discussion / Conclusions
Quotes: "No randomised controlled trials (RCTs) and controlled clinical trials (CCTs) evaluating minimally invasive surgery (MIS) and open surgery for the treatment of solid intra-thoracic or intra-abdominal neoplasms in children could be identified. The current evidence base informing the use of MIS in children with solid abdominal and thoracic neoplasms is based on other study designs such as case series, retrospective chart reviews and cohort studies and should be interpreted with caution. Thus there is insufficient evidence to allow any definitive conclusions regarding overall survival, event-free survival, port-site metastases, recurrence rate and surgical morbidity associated with the use of MIS in these patients."
Reasoning: The authors provide an overall interpretation of the results in the context of the limitations and current evidence base.
[Yes]
P27. Funding
Quotes: "Stichting Kinderen Kankervrij (KIKA), Netherlands." under "External sources"
Reasoning: The authors report the source of funding for the review.
[Yes]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
1
|
0
|
0
|
NA
|
NA
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
0
|
1
|
0
|
0
|
1
|
1
|
0
|
0
|
0
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
1
|
1
|
0
|
NA
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
NA
|
NA
|
1
|
1
|
0
|
0
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
1
|
1
|
1
|
1
|
0
|
0
|
0
|
0
|
NA
|
NA
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
NA
|
0
|
LLM response
33 quote(s) from
publication full text (mean similarity 99%)
A1
Quote: "The objective of this systematic review is to compare the effectiveness of NSS as compared with RN for the treatment of children with WT."
The research question and objective are clearly stated.
[Yes]
A2
Quotes: "Manuscripts were assessed and data abstracted in duplicate with differences resolved by the senior author. Owing to high heterogeneity among the final included studies, only a qualitative systematic review was performed; no formal meta-analysis was undertaken."
"We excluded 15 studies owing to a focus on disease other than WT; 5 studies owing to inability to extract out pediatric-specific data; 18 studies owing to duplicate reporting or review of previous reports; and 15 studies owing to insufficient reporting to allow for patients with RN and NSS."
Study selection and data extraction were done in duplicate.
[Yes]
A3
Quotes: "The initial literature search was designed and executed by a reference librarian at our institution (M.V.N.). We searched MEDLINE, EMBASE, the Cochrane Controlled Trials Register, Google Scholar, and Scopus electronic databases for studies published between 1980 and 2014 based on Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines [19]. The exploded search terms were: "nephron-sparing surgery," "partial nephrectomy," or "nephron sparing surgery," restricted to "tumor," "mass," "Wilms," "cancer," or "renal cell carcinoma." These were then restricted to articles retrieved under a second search for the exploded search terms "pediatric," "child," or "children". Reference lists of included studies were manually screened for any additional studies."
A comprehensive literature search was performed using multiple electronic databases, reference lists, and no language restrictions.
[Yes]
A4
Quote: "We included English-language studies of children (aged 18 y or younger) diagnosed with WT that compared the outcomes or effects of NSS vs. RN. No manuscript was excluded based on method of analysis, definition of success, perceived quality, or susceptibility to bias."
The inclusion criteria did not place restrictions on publication type.
[Yes]
A5
Quote: "A total of 694 publications were identified using our search criteria, with an additional 3 reports identified by hand-searching bibliographies of included studies and conference abstracts. Of these, 118 studies were selected for full-text review. We excluded 15 studies owing to a focus on disease other than WT; 5 studies owing to inability to extract out pediatric-specific data; 18 studies owing to duplicate reporting or review of previous reports; and 15 studies owing to insufficient reporting to allow for patients with RN and NSS."
A PRISMA flow diagram is provided detailing the number of included and excluded studies with reasons.
[Yes]
A6
Quote: "In total, 4,022 patients were included. Of these, 1,632 children (41%) were male patients. Reported ages ranged from <1 month to 18 years. Bilateral tumors were present in 1,153 (29%) patients, including at least 4 metachronous contralateral tumors. The reported mean size of excised tumors ranged from 5 to 14 cm for RN and 1.5 to 9 cm for NSS. NSS was performed in 1,040 (26%) patients and 1,311 (32%) kidneys, whereas RN was performed in 2,962 (74%) patients and 2,844 (68%) kidneys."
Aggregated characteristics of the included studies are provided.
[Yes]
A7
Quotes: "All studies were then assessed for methodological quality and analyses were performed using EndNote version X7.3 (Thomson Reuters, New York, NY), SAS version 5.4 (SAS Institute, Cary, NC), and RevMan version 5.3.5 (Nordic Cochrane Centre of the Cochrane Collaboration, Copenhagen, Denmark)."
"Instead, we planned to perform only a qualitative, nonpooled systematic review. All studies were tracked and analyses were performed using EndNote version X7.3 (Thomson Reuters, New York, NY), SAS version 5.4 (SAS Institute, Cary, NC), and RevMan version 5.3.5 (Nordic Cochrane Centre of the Cochrane Collaboration, Copenhagen, Denmark)."
The methodological quality of included studies was assessed.
[Yes]
A8
Quote: "As with any systematic review, the reader must be wary of a "garbage in, garbage out" phenomenon, whereby the systematic review serves only to amplify the limitations of an initial study. Nevertheless, we hope that these limitations have been mitigated by the authors' relative caution in amplifying significant findings (and significant nonfindings)."
The authors acknowledge that the conclusions are limited by the quality of the included studies.
[Yes]
A9
Quote: "Owing to high heterogeneity among the final included studies, only a qualitative systematic review was performed; no formal meta-analysis was undertaken."
A meta-analysis was not performed due to high heterogeneity among the included studies.
[NA]
A10
The systematic review did not assess publication bias.
[NA]
A11
Quotes: "Received 15 May 2015; received in revised form 30 June 2015; accepted 6 July 2015"
"Corresponding author. Tel.: +1-919-684-6994; fax: +1-919-681-5507. E-mail address: Jonathan.Routh@duke.edu (J.C. Routh)."
The funding source is reported but the sources of support for the included studies are not reported.
[No]
P1
Quote: "Nephron-sparing surgery for Wilms tumor: A systematic review"
The title identifies the report as a systematic review.
[Yes]
P2
The abstract is structured with labeled sections for background, methods, results, and conclusions.
[Yes]
P3
Quote: "Radical nephrectomy (RN, or total nephrectomy) is the current gold-standard surgical treatment for children with Wilms tumors (WT). However, nephron-sparing surgery (NSS, or partial nephrectomy) has recently been increasing in attention. The objective of this systematic review is to compare the effectiveness of NSS as compared with RN for the treatment of children with WT."
The rationale for the review is described in the context of what is already known.
[Yes]
P4
Quote: "The objective of this systematic review is to compare the effectiveness of NSS as compared with RN for the treatment of children with WT."
The review objective is explicitly stated.
[Yes]
P5
The systematic review does not mention a protocol or registration number.
[No]
P6
Quote: "We included English-language studies of children (aged 18 y or younger) diagnosed with WT that compared the outcomes or effects of NSS vs. RN. No manuscript was excluded based on method of analysis, definition of success, perceived quality, or susceptibility to bias. In cases of ambiguity or where study reporting made evaluation difficult, we attempted to err on the side of inclusiveness."
The eligibility criteria are specified.
[Yes]
P7
Quote: "The initial literature search was designed and executed by a reference librarian at our institution (M.V.N.). We searched MEDLINE, EMBASE, the Cochrane Controlled Trials Register, Google Scholar, and Scopus electronic databases for studies published between 1980 and 2014 based on Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines [19]."
Information sources are described but the date last searched is not provided.
[No]
P8
The full search strategy is not presented.
[No]
P9
Quote: "A total of 694 publications were identified using our search criteria, with an additional 3 reports identified by hand-searching bibliographies of included studies and conference abstracts. Of these, 118 studies were selected for full-text review. We excluded 15 studies owing to a focus on disease other than WT; 5 studies owing to inability to extract out pediatric-specific data; 18 studies owing to duplicate reporting or review of previous reports; and 15 studies owing to insufficient reporting to allow for patients with RN and NSS."
The study selection process is described.
[Yes]
P10
Quote: "Manuscripts were assessed and data abstracted in duplicate with differences resolved by the senior author."
The data collection process is described.
[Yes]
P11
The systematic review does not explicitly state all the variables for which data were sought.
[No]
P12
Quote: "All studies were then assessed for methodological quality and analyses were performed using EndNote version X7.3 (Thomson Reuters, New York, NY), SAS version 5.4 (SAS Institute, Cary, NC), and RevMan version 5.3.5 (Nordic Cochrane Centre of the Cochrane Collaboration, Copenhagen, Denmark)."
Methods for assessing risk of bias of individual studies are mentioned but not described in detail.
[No]
P13
The systematic review does not state the principal summary measures.
[No]
P14
Quote: "Owing to high heterogeneity among the final included studies, only a qualitative systematic review was performed; no formal meta-analysis was undertaken."
A meta-analysis was not performed.
[NA]
P15
The systematic review does not specify any assessment of risk of bias across studies.
[NA]
P16
The systematic review does not describe any additional analyses.
[NA]
P17
Quote: "A total of 694 publications were identified using our search criteria, with an additional 3 reports identified by hand-searching bibliographies of included studies and conference abstracts. Of these, 118 studies were selected for full-text review. We excluded 15 studies owing to a focus on disease other than WT; 5 studies owing to inability to extract out pediatric-specific data; 18 studies owing to duplicate reporting or review of previous reports; and 15 studies owing to insufficient reporting to allow for patients with RN and NSS."
A PRISMA flow diagram is provided giving the numbers of studies screened, assessed for eligibility, included, and excluded with reasons at each stage.
[Yes]
P18
Quote: "Most studies were from Europe (29, 41%) and North America (22, 31%), although studies were also reported from Africa (12, 17%), Asia (5, 7%), and South America (3, 4%). Of individual countries, the United States (20, 28%) and Italy (10, 14%) were the most frequently represented."
Study characteristics are presented for each included study in Table 1.
[Yes]
P19
The systematic review does not present data on the risk of bias in each study.
[No]
P20
Quote: "Surgical and oncologic outcomes data were presented in highly variable ways among the included studies. Owing to these differences in reporting among studies in conjunction with a lack of individual patient data, direct comparisons of outcomes data (e.g., overall or event-free survival rates after RN and NSS) was not performed."
Results for individual studies are not presented.
[No]
P21
Quote: "Owing to high heterogeneity among the final included studies, only a qualitative systematic review was performed; no formal meta-analysis was undertaken."
A meta-analysis was not performed.
[NA]
P22
The systematic review did not assess risk of bias across studies.
[NA]
P23
The systematic review did not perform any additional analyses.
[NA]
P24
Quote: "In this study, we found that most studies detailing outcomes of surgical techniques for resection of WT were retrospective cohorts and case series. Differences in reporting and cohort heterogeneity among the included studies negated the possibility of meaningful, pooled comparisons of RN and NSS outcomes. Nevertheless, most current studies of patients with RN and NSS appear to show similar tumor rupture, recurrence, ESRD, and overall survival outcomes between the 2 techniques."
The main findings are summarized.
[Yes]
P25
Quote: "As with any systematic review, the reader must be wary of a "garbage in, garbage out" phenomenon, whereby the systematic review serves only to amplify the limitations of an initial study. Nevertheless, we hope that these limitations have been mitigated by the authors' relative caution in amplifying significant findings (and significant nonfindings)."
Limitations at the study and review level are discussed.
[Yes]
P26
Quote: "Perhaps the most important issue to consider is that of patient selection. The authors were unable to extract enough data regarding tumor size, tumor location, or residual amount of healthy parenchyma to tease out their effects on patient selection. Previous studies by Cost et al. [15] and Ferrar et al. [42] suggest that only 25% of children with unilateral WT are candidates for NSS; however, only 1% of these children actually undergo NSS [34]. Thus, one of the goals of future research efforts should be to determine which children can safely undergo NSS. In a recent abstract, Ehrlich et al. reported on 39 patients with unilateral WT who underwent NSS. The authors found that 9/39 (23%) were found to have positive margins or intraoperative tumor spill; these patients thus would have received additional chemotherapy and radiation owing to surgical factors. Despite this, the 5-year overall survival in those patients was 96%. Although this study has to date only been reported in abstract form, the presented data seems to imply that at least some of these tumors may not have been appropriate candidates for NSS. Preoperative tumor weights in these patients ranged from 133 to 1,870 g, whereas 13 patients had Stage II or III disease. Further, based on the fact that 13/39 (33%) patients did not undergo formal lymphadenectomy as recommended, one can perhaps conclude that the surgeons involved in those cases may not have been fully up to date on standard COG guidelines [34]. NSS feasibility, however, can be aided by preoperative imaging and was associated with a sensitivity of 87%, specificity of 97%, and accuracy of 93% [43]. As noted previously, NSS is a technically demanding procedure that requires significant expertise both in patient selection and technical ability and experience."
A general interpretation of the results in the context of other evidence and implications for future research are provided.
[Yes]
P27
Quote: "Received 15 May 2015; received in revised form 30 June 2015; accepted 6 July 2015"
Sources of funding for the systematic review are not described.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
1
|
NA
|
1
|
NA
|
NA
|
NA
|
NA
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
0
|
NA
|
NA
|
NA
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
1
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
1
|
1
|
1
|
1
|
0
|
NA
|
NA
|
NA
|
NA
|
NA
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
NA
|
NA
|
NA
|
NA
|
NA
|
NA
|
0
|
LLM response
29 quote(s) from
publication full text (mean similarity 98.7%)
A1 - A priori design
Quote: "The protocol for this review was published in The Cochrane Library in Issue 3, 2006. The Methods section of the original protocol has been reorganised and some parts of it re-labelled to meet the standards of the latest version of the Cochrane Handbook for Systematic Reviews of Interventions (Higgins 2011)."
Reasoning: The review had a published protocol.
[Yes]
A2 - Duplicate study selection and data extraction
Quotes: "The review authors worked independently to select trials; none were identified."
"Both review authors (AVR and PB) independently selected abstracts and screened potential trials. Both review authors (AVR and PB) contributed to writing the text of this review."
Reasoning: The two review authors independently selected studies and wrote the review.
[Yes]
A3 - Comprehensive literature search
Quotes: "We searched the following databases on 23 March 2012: the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE, EMBASE, CINAHL, LILACS and ISI Web of Science. Previously, we searched the Child Health Library in June 2009. We also performed online searches of trial registries, medical journals, conference proceedings, dissertations and theses."
Reasoning: Multiple databases and other sources were searched.
[Yes]
A4 - Grey literature search
Quote: "We also performed online searches of trial registries, medical journals, conference proceedings, dissertations and theses."
Reasoning: Grey literature sources like dissertations and theses were searched.
[Yes]
A5 - List of included and excluded studies
Quote: "We identified no trials that satisfied the criteria for this review."
Reasoning: No studies were included or excluded.
[NA]
A6 - Characteristics of included studies
Quote: "We identified no trials that satisfied the criteria for this review."
Reasoning: No studies were included.
[NA]
A7 - Assessment of risk of bias in included studies
Quote: "We identified no trials meeting the inclusion criteria."
Reasoning: No studies were included to assess for risk of bias.
[NA]
A8 - Appropriate use of scientific quality
Quote: "We identified no trials meeting the inclusion criteria."
Reasoning: No studies were included to use their quality in formulating conclusions.
[NA]
A9 - Appropriate methods to combine findings
Quote: "We identified no trials meeting the inclusion criteria."
Reasoning: No studies were included to combine in a meta-analysis.
[NA]
A10 - Assessment of publication bias
Quote: "We identified no trials meeting the inclusion criteria."
Reasoning: No studies were included to assess publication bias.
[NA]
A11 - Conflict of interest stated
Quotes: "Internal sources: No sources of support supplied"
"External sources: Cerebra (Charity for Brain Injured Children and Young People), UK."
Reasoning: Sources of support for the review were stated, but no included studies existed to report COI for.
[No]
P1 - Title
Quote: "Fundoplication versus postoperative medication for gastro-oesophageal reflux in children with neurological impairment undergoing gastrostomy (Review)"
Reasoning: The title identifies the article as a systematic review.
[Yes]
P2 - Structured abstract
The abstract contains labeled sections for Background, Objectives, Search methods, Selection criteria, Data collection and analysis, Main results, and Authors' conclusions.
Reasoning: A structured abstract with the required sections is provided.
[Yes]
P3 - Rationale
Quote: "Children with neurological impairments frequently experience feeding difficulties, which can lead to malnutrition and growth failure. Gastrostomy feeding is now the preferred method of providing nutritional support to children with neurological impairments who are unable to adequately meet their nutritional requirements orally. Complications of gastrostomy placement include infection, perforation, bleeding, tube migration/dislocation, intestinal fistulas and obstruction (Razeghi 2002). In addition, the development of significant gastro-oesophageal reflux (GOR) has been widely reported and is considered to be one of the long-term adverse effects of gastrostomy placement (Mollitt 1985; Razeghi 2002)."
Reasoning: The rationale for the review is described in the context of what is known about the condition and intervention.
[Yes]
P4 - Objectives
Quote: "To compare the effectiveness of antireflux surgery and antireflux medications for children with neurological impairments and GOR who are undergoing placement of a gastrostomy feeding tube."
Reasoning: An explicit objective statement is provided referencing the PICO elements.
[Yes]
P5 - Protocol and registration
Quote: "The protocol for this review was published in The Cochrane Library in Issue 3, 2006."
Reasoning: The existence and accessibility of a protocol is indicated.
[Yes]
P6 - Eligibility criteria
Quote: "We sought to include randomised controlled trials that recruited children up to the age of 18 years with neurological impairments and GOR who were undergoing gastrostomy tube insertion."
Reasoning: The eligibility criteria for participants, interventions, and study design are stated.
[Yes]
P7 - Information sources
Quotes: "We searched the following databases on 23 March 2012: the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE, EMBASE, CINAHL, LILACS and ISI Web of Science. Previously, we searched the Child Health Library in June 2009. We also performed online searches of trial registries, medical journals, conference proceedings, dissertations and theses."
Reasoning: All information sources searched are described with the dates of coverage and last search date.
[Yes]
P8 - Search
The full search strategies for CENTRAL, MEDLINE, EMBASE, and CINAHL are provided in Appendix 1.
Reasoning: The full search strategy for at least one database is presented.
[Yes]
P9 - Study selection
Quote: "The review authors worked independently to select trials; none were identified."
Reasoning: The process for selecting studies is described.
[Yes]
P10 - Data collection process
Quote: "Data extraction forms will be designed to include study design, participant characteristics, study setting, intervention type and outcomes. Data will be extracted independently by two review authors (AVR and PBS) and disagreements will be resolved through discussion or by contacting the study author for further information."
Reasoning: The planned method of data extraction is described, but was not carried out as no studies were included.
[Yes]
P11 - Data items
Quote: "Data extraction forms will be designed to include study design, participant characteristics, study setting, intervention type and outcomes."
Reasoning: The data items sought are listed.
[Yes]
P12 - Risk of bias in individual studies
Quote: "Selected studies will be independently evaluated by two review authors (AVR and PBS) using the Cochrane Collaboration's tool for assessing the risk of bias (Higgins 2011). Disagreements over suitability for inclusion will be resolved by discussion or adjudication, or both, by editors of the Cochrane Developmental, Psychosocial and Learning Problems Group."
Reasoning: The risk of bias assessment method is specified.
[Yes]
P13 - Summary measures
Quote: "Binary data"
Reasoning: The summary measure of risk ratio is mentioned.
[Yes]
P14 - Synthesis of results
Quote: "We identified no trials meeting the inclusion criteria."
Reasoning: No studies were included to synthesize results.
[NA]
P15 - Risk of bias across studies
Quote: "We will attempt to avoid publication bias by seeking data from all sources including conference proceedings and unpublished data from pharmaceutical companies (see search strategy)."
Reasoning: Methods to assess risk of bias across studies like publication bias are mentioned.
[Yes]
P16 - Additional analyses
Quotes: "If sufficient data are identified, we anticipate undertaking subgroup analyses as follows: 1. degree of clinically measured symptomatic gastro-oesophageal reflux prior to gastrostomy surgery; 2. level of disability; 3. presence of underlying seizure disorders or pulmonary disease."
"We will conduct a sensitivity analysis to assess the impact of study quality on the outcome of the meta-analysis."
Reasoning: Planned subgroup analyses and sensitivity analysis are described.
[Yes]
P17 - Study selection
Quote: "We identified no trials that satisfied the criteria for this review."
Reasoning: The number of studies screened and included is reported, but a flow diagram is not provided.
[No]
P18 - Study characteristics
Quote: "We identified no trials that satisfied the criteria for this review."
Reasoning: No studies were included to report characteristics for.
[NA]
P19 - Risk of bias within studies
Quote: "We identified no trials meeting the inclusion criteria."
Reasoning: No studies were included to report risk of bias for.
[NA]
P20 - Results of individual studies
Quote: "We identified no trials that satisfied the criteria for this review."
Reasoning: No studies were included to report results for.
[NA]
P21 - Synthesis of results
Quote: "We identified no trials meeting the inclusion criteria."
Reasoning: No studies were included to synthesize in a meta-analysis.
[NA]
P22 - Risk of bias across studies
Quote: "We identified no trials meeting the inclusion criteria."
Reasoning: No studies were included to assess risk of bias across studies for.
[NA]
P23 - Additional analysis
Quote: "We identified no trials meeting the inclusion criteria."
Reasoning: No studies were included to perform additional analyses on.
[NA]
P24 - Summary of evidence
Quote: "There remains considerable uncertainty regarding the optimal treatment when faced with the decision of fundoplication surgery versus antireflux medications for children with GOR and neurological impairment who are undergoing gastrostomy insertion. There is a need for robust scientific evidence in order to provide data on the comparable risks or benefits of the two interventions."
Reasoning: The main findings and strength of evidence are summarized.
[Yes]
P25 - Limitations
Quote: "While it is important to acknowledge that any research performed with this group of children will be difficult due to their anatomical and physiological problems, this is a population with ever increasing health needs and this is an area that is critically in need of research."
Reasoning: Limitations at the review level regarding lack of evidence are discussed.
[Yes]
P26 - Conclusions
Quote: "There remains considerable uncertainty regarding the optimal treatment when faced with the decision of fundoplication surgery versus antireflux medications for children with GOR and neurological impairment who are undergoing gastrostomy insertion. There is a need for robust scientific evidence in order to provide data on the comparable risks or benefits of the two interventions."
Reasoning: A general interpretation is provided in the context of the results.
[Yes]
P27 - Funding
Quotes: "Internal sources: No sources of support supplied"
"External sources: Cerebra (Charity for Brain Injured Children and Young People), UK."
Reasoning: Sources of funding for the review are reported.
[Yes]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
NA
|
NA
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
0
|
0
|
1
|
0
|
1
|
1
|
0
|
0
|
0
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
1
|
1
|
1
|
NA
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
NA
|
NA
|
1
|
1
|
0
|
0
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
1
|
1
|
1
|
0
|
0
|
1
|
1
|
1
|
NA
|
NA
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
0
|
0
|
1
|
0
|
NA
|
1
|
0
|
0
|
LLM response
19 quote(s) from
publication full text (mean similarity 97.7%)
A1
Quotes: "We used a Delphi-like method [16] to determine the issues of greatest concern to pediatric surgeons regarding the surgical management of cryptorchid testes."
Reasoning: The research question and inclusion criteria were established a priori using a Delphi method.
[Yes]
A2
Quotes: "Two reviewers independently assessed each included study and compared the scores for each item on the applicable quality assessment tool to reach a consensus. If no consensus could be reached, they consulted a third reviewer."
Reasoning: Study selection and data extraction were performed in duplicate by two independent reviewers, with a consensus process.
[Yes]
A3
Quotes: "We conducted electronic searches of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and CINAHL from inception to September 2014."
Reasoning: At least two electronic databases were searched, covering a comprehensive date range.
[Yes]
A4
Quotes: None relevant.
Reasoning: The inclusion of grey literature is not mentioned.
[No]
A5
Quotes: None relevant.
Reasoning: A list of included and excluded studies is not provided.
[No]
A6
Quotes: "The remaining 31 studies comprised 1,285 SRs and 29 non-randomized studies. Due to the heterogeneity of the data, meta-analysis was not possible. Ultrasound and magnetic resonance imaging are insufficient for identification or localization of IAT; laparoscopic or surgical exploration is necessary."
Reasoning: Aggregate data on the characteristics of included studies is provided.
[Yes]
A7
Quotes: "We identified two relevant SRs and 29 non-randomized studies. Due to the heterogeneity of the data, meta-analysis was not possible."
Reasoning: The scientific quality of included studies was not systematically assessed.
[No]
A8
Quotes: None relevant.
Reasoning: Not applicable since study quality was not assessed (A7).
[NA]
A9
Quotes: "Due to the heterogeneity of the data, a meta-analysis was not possible."
Reasoning: Meta-analysis was not performed due to heterogeneity of the data.
[Yes]
A10
Quotes: None relevant.
Reasoning: Publication bias was not assessed.
[No]
A11
Quotes: "The authors declare that they have no conflict of interest."
Reasoning: Conflicts of interest for the systematic review are reported, but not for the individual included studies.
[No]
P1
Quotes: "What is the ideal surgical approach for intra-abdominal testes? a systematic review"
Reasoning: The title identifies the article as a systematic review.
[Yes]
P2
Quotes: The abstract contains labeled sections for Background, Methods, Results, Conclusions.
Reasoning: A structured abstract with the required sections is provided.
[Yes]
P3
Quotes: "In approximately 2–5 % of males, one or both testes fail to descend into the scrotum by birth [1, 2]. Many of these testes will descend spontaneously within the first year, but approximately 23 % will remain cryptorchid without surgical correction [3]."
Reasoning: The introduction describes the rationale for the review in the context of what is already known about cryptorchidism.
[Yes]
P4
Quotes: "We used a Delphi-like method [16] to determine the issues of greatest concern to pediatric surgeons regarding the surgical management of cryptorchid testes."
Reasoning: The introduction states the review question, referring to the population (cryptorchid testes) and intervention (surgical management).
[Yes]
P5
Quotes: None relevant.
Reasoning: The existence of a review protocol is not mentioned.
[No]
P6
Quotes: None relevant.
Reasoning: Eligibility criteria are not explicitly stated.
[No]
P7
Quotes: "We conducted electronic searches of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and CINAHL from inception to September 2014 (the date range was limited due to an abundance of literature), as well as reference lists of included studies."
Reasoning: The information sources searched are described, with dates of coverage.
[Yes]
P8
Quotes: None relevant.
Reasoning: The full search strategy is not presented.
[No]
P9
Quotes: "Two reviewers independently assessed each included study and compared the scores for each item on the applicable quality assessment tool to reach a consensus. If no consensus could be reached, they consulted a third reviewer."
Reasoning: The process for selecting studies is described.
[Yes]
P10
Quotes: "One reviewer extracted data from each of the included studies, and a second reviewer checked the data for accuracy and completeness. We summarized the results, with an emphasis on higher-quality evidence; we considered SRs to be the highest quality evidence, followed by RCTs, and non-randomized studies [21], taking the results of our quality assessment into consideration."
Reasoning: The data collection process is described.
[Yes]
P11
Quotes: None relevant.
Reasoning: Data items are not defined.
[No]
P12
Quotes: "We identified two relevant SRs and 29 non-randomized studies. Due to the heterogeneity of the data, meta-analysis was not possible."
Reasoning: Risk of bias in individual studies was not assessed.
[No]
P13
Quotes: None relevant.
Reasoning: Summary measures are not stated.
[No]
P14
Quotes: "Due to the heterogeneity of the data, a meta-analysis was not possible."
Reasoning: Meta-analysis was not performed.
[NA]
P15
Quotes: None relevant.
Reasoning: Risk of bias across studies was not assessed.
[NA]
P16
Quotes: None relevant.
Reasoning: Additional analyses were not performed.
[NA]
P17
Quotes: "Our initial search yielded 774 studies. After title-abstract screening, 224 studies remained. Due to this abundance of literature, we limited the date range to January 2008–September 2014, reducing the total number of articles to 48. We performed full-text screening for these articles, excluding 17 that did not meet our criteria [7, 10, 22–36]. The remaining 31 studies comprised 1,285 SRs and 29 non-randomized studies; we quality assessed and summarized these studies (Table 1)."
Reasoning: A flow diagram is not provided, but the number of studies at each stage of screening is reported in the text.
[Yes]
P18
Quotes: Table 1 presents the characteristics of included studies.
Reasoning: Study characteristics are provided in an aggregated table.
[Yes]
P19
Quotes: None relevant.
Reasoning: Risk of bias of individual studies was not assessed.
[No]
P20
Quotes: None relevant.
Reasoning: Results of individual studies are not presented.
[No]
P21
Quotes: "Due to the heterogeneity of the data, a meta-analysis was not possible."
Reasoning: Meta-analysis was not performed.
[NA]
P22
Quotes: None relevant.
Reasoning: Risk of bias across studies was not assessed.
[NA]
P23
Quotes: None relevant.
Reasoning: Additional analyses were not performed.
[NA]
P24
Quotes: "There is a paucity of good-quality evidence on this topic; however, we cautiously recommend the following: location and diagnosis of IAT should be conducted via laparoscopy, followed by inguinal canal exploration if necessary; low IAT should be corrected by primary orchiopexy, while high IAT should be corrected by either one- or two-stage FSO, according to the surgeon's preference; the decision to perform an open or laparoscopic procedure should also be based on the surgeon's preference. Further studies—particularly RCTs—are needed to confirm the validity of these recommendations, and to improve the current surgical techniques for optimization of long-term outcomes."
Reasoning: The main findings are summarized, considering their relevance to key groups.
[Yes]
P25
Quotes: "This is a fairly comprehensive systematic review, as our search included four major databases; however, it is possible that we missed some evidence by limiting our review to English language, published literature. It should also be noted that most of the evidence that we identified came from non-randomized studies—a design that inherently possesses several sources of potential bias, particularly related to the selection of study participants and the reporting of results [19, 67–69]."
Reasoning: Limitations at the study and review level are discussed.
[Yes]
P26
Quotes: "By synthesizing the evidence and providing clear assessments of the quality of the available evidence, we hope to encourage evidence-based practice in pediatric surgery and stimulate further research in areas where good-quality evidence is lacking."
Reasoning: A general interpretation is provided in the context of other evidence and implications for future research.
[Yes]
P27
Quotes: None relevant.
Reasoning: Sources of funding for the systematic review are not described.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
0
|
0
|
0
|
1
|
0
|
0
|
0
|
NA
|
NA
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
0
|
0
|
1
|
0
|
0
|
1
|
0
|
0
|
0
|
NA
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
0
|
0
|
0
|
NA
|
NA
|
NA
|
NA
|
1
|
0
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
NA
|
NA
|
0
|
0
|
0
|
NA
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
1
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
0
|
NA
|
NA
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
0
|
0
|
0
|
0
|
0
|
0
|
NA
|
NA
|
NA
|
0
|
LLM response
17 quote(s) from
publication full text (mean similarity 100%)
A1
"An analysis of Medline-published therapeutic options in the treatment of SBS was performed."
The authors state that they performed an analysis of therapeutic options, implying an a priori design.
[Yes]
A2
No relevant quotes found.
The authors do not mention duplicate study selection and data extraction.
[No]
A3
"Articles were found using "short bowel syndrome", "children", "therapy", "parenteral nutrition", "surgical treatment", "recirculating loops", "reverse segments", "Bianchi procedure", "STEP", "small bowel transplantation", and "tissue engineering" as search items."
The authors searched Medline using several relevant search terms.
[No]
A4
No relevant quotes found.
The authors do not mention including grey literature.
[No]
A5
No relevant quotes found.
The authors do not provide a list of included and excluded studies.
[No]
A6
"Conducting the Medline-analysis using the mentioned main search items yielded 787 publications. Selection criteria consisted of (1) application of the treatment strategy in humans or (2) application of the tissue engineering. After applying these criteria, only 81 publications were included in the analysis."
The authors provide some aggregate information about the included studies, such as the number of publications and selection criteria.
[No]
A7
No relevant quotes found.
The authors do not mention assessing the quality of included studies.
[No]
A8
No relevant quotes found.
Since study quality was not assessed, it could not have been used to formulate conclusions.
[NA]
A9
No relevant quotes found.
The authors did not perform a meta-analysis or quantitative synthesis.
[NA]
A10
No relevant quotes found.
The authors did not assess publication bias.
[NA]
A11
No relevant quotes found.
The authors do not report on conflicts of interest of the included studies.
[No]
P1
"Current practice and future perspectives in the treatment of short bowel syndrome in children—a systematic review"
The title identifies the article as a systematic review.
[Yes]
P2
The abstract is structured with labeled sections for Purpose, Methods, Results, and Conclusion.
The abstract is structured and contains most of the required elements.
[Yes]
P3
"Short bowel syndrome (SBS) is a malabsorption disorder of the intestine, which leads to an inadequate alimentary supply. A number of therapeutic approaches are already in use, but research advances may provide new options in the future."
The introduction describes the rationale for the review in the context of what is known about short bowel syndrome and its treatment.
[Yes]
P4
"The purpose of this paper was to provide an overview of the established therapeutic approaches together with a discussion of the future perspectives in the treatment of patients with SBS."
The introduction states the purpose of the review, but does not fully specify the PICOS.
[No]
P5
No relevant quotes found.
The authors do not mention a review protocol or registration.
[No]
P6
"Selection criteria consisted of (1) application of the treatment strategy in humans or (2) application of the tissue engineering."
The authors specify the selection criteria for included studies.
[Yes]
P7
"An analysis of Medline-published therapeutic options in the treatment of SBS was performed."
The authors searched Medline but do not provide the dates of coverage or date last searched.
[No]
P8
No relevant quotes found.
The authors do not present the full search strategy.
[No]
P9
"Conducting the Medline-analysis using the mentioned main search items yielded 787 publications. Selection criteria consisted of (1) application of the treatment strategy in humans or (2) application of the tissue engineering. After applying these criteria, only 81 publications were included in the analysis."
The authors describe the process for selecting studies.
[Yes]
P10
No relevant quotes found.
The authors do not describe the method of data extraction.
[No]
P11
No relevant quotes found.
The authors do not specify all the data items sought.
[No]
P12
No relevant quotes found.
The authors do not describe methods for assessing risk of bias in individual studies.
[No]
P13
No relevant quotes found.
The authors do not state the principal summary measures, as no quantitative synthesis was performed.
[NA]
P14
No relevant quotes found.
The authors did not perform quantitative synthesis.
[NA]
P15
No relevant quotes found.
The authors did not assess risk of bias across studies.
[NA]
P16
No relevant quotes found.
The authors did not perform any additional analyses.
[NA]
P17
"Conducting the Medline-analysis using the mentioned main search items yielded 787 publications" [...] " After applying these criteria, only 81 publications were included in the analysis."
The authors report the number of studies included but not the full study selection process with reasons for exclusion at each stage or a flow diagram.
[No]
P18
No relevant quotes found.
The authors do not provide characteristics of the individual included studies.
[No]
P19
No relevant quotes found.
The authors did not assess risk of bias within individual studies.
[No]
P20
No relevant quotes found.
The authors did not provide results for individual studies, as no quantitative synthesis was performed.
[NA]
P21
No relevant quotes found.
The authors did not perform a meta-analysis.
[NA]
P22
No relevant quotes found.
The authors did not assess risk of bias across studies.
[NA]
P23
No relevant quotes found.
The authors did not perform any additional analyses.
[NA]
P24
"Although surgical and non-surgical therapeutic options have improved significantly in the last decade, various unsolved issues regarding the treatment of SBS persist. Even when parenteral nutrition and catheter-preserving care are conducted in an optimal way, the long-time survival rate of patients with SBS remains low [7]."
The discussion summarizes the main findings.
[Yes]
P25
"To date, it has been taken into account that evidence of benefit exists only for bowel lengthening procedures and SBTx. All further approaches have failed or are still in an experimental stage."
The authors acknowledge some limitations of the evidence for the treatment approaches discussed.
[Yes]
P26
"To treat SBS patients, different types of stimulants have been tested in various clinical studies. These tests have shown that growth hormone and glucagon-like peptide 2 are the most promising therapeutic agents, but neither is used as a standardized procedure so far because the long-term outcome and long-term complications remain undefined."
The authors discuss implications for future research.
[Yes]
P27
"Acknowledgments We are very grateful that this publication has been supported by "Heidelberger Stiftung Chirurgie." Conflicts of interest None."
The authors report no conflicts of interest and acknowledge a funding source that supported the publication.
[Yes]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
1
|
0
|
1
|
0
|
0
|
1
|
1
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
1
|
NA
|
1
|
1
|
0
|
1
|
1
|
1
|
0
|
1
|
0
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
1
|
0
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
0
|
0
|
1
|
1
|
0
|
0
|
1
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
0
|
0
|
0
|
0
|
1
|
0
|
0
|
1
|
0
|
0
|
LLM response
28 quote(s) from
publication full text (mean similarity 99.2%)
1
quote(s) from the LLM prompt briefing (mean similarity 100%) -
were instructions quoted (ok) or examples (unwanted beahviour)?
A1. Was an 'a priori' design provided?
Quotes: "The objective of this review was to systematically evaluate the incidence of a metachronous contralateral inguinal hernia (MCIH) in children with unilateral inguinal hernia and therefore to propose or to reject routine contralateral groin exploration."
Reasoning: The objective is clearly stated, but there is no mention of a protocol, ethics approval, or pre-determined research objectives.
[No]
A2. Was there duplicate study selection and data extraction?
Quotes: "Data from selected studies were extracted by two authors (RNV and KW). Extracted data were managed using a preformed Excel data sheet."
Reasoning: Two authors independently extracted data, but it is not clear if study selection was done in duplicate.
[No]
A3. Was a comprehensive literature search performed?
Quotes: "The Cochrane Central Register of Controlled Trials (The Cochrane library issue 7 of 12, July 2014), MEDLINE (January 1966 to August 2014) and EMBASE (1947 to August 2014) were searched (Appendix 1 for detailed search strategy). The search was restricted to English and German articles."
Reasoning: At least 2 databases plus reference lists were searched, but no supplementary sources like grey literature were searched.
[No]
A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion?
Quotes: None relevant.
Reasoning: There is no mention of including grey literature or unpublished studies.
[No]
A5. Was a list of studies (included and excluded) provided?
Quotes: None relevant.
Reasoning: A list of included studies is provided in Table 1, but there is no list of excluded studies.
[No]
A6. Were the characteristics of the included studies provided?
Quotes: "In an aggregated form such as a table, data from the original studies should be provided on the participants, interventions and outcomes."
Reasoning: Table 1 provides the key characteristics of the included studies in an aggregated form.
[Yes]
A7. Was the scientific quality of the included studies assessed and documented?
Quotes: "We examined heterogeneity between studies with standard chi-square tests and calculated the I-square statistics, which measure the proportion of variation in treatment effect estimates due to between-study heterogeneity [14]. Depending on the result of the heterogeneity test, fixed or random effect models were used to combine the results from the different studies [15]."
Reasoning: The authors assessed heterogeneity between studies, which is one aspect of study quality, but did not use a comprehensive quality assessment tool.
[No]
A8. Was the scientific quality of the included studies used appropriately in formulating conclusions?
Quotes: None relevant.
Reasoning: Since a comprehensive quality assessment was not done, the quality could not be incorporated into the conclusions.
[No]
A9. Were the methods used to combine the findings of studies appropriate?
Quotes: "Depending on the result of the heterogeneity test, fixed or random effect models were used to combine the results from the different studies [15]. If homogeneity can be assumed each study gets a weight given by the reciprocal of the squared standard error. If heterogeneity needs to be taken into account, the weights are adapted accordingly and are given by the reciprocal of the sum of the squared standard error and the estimated heterogeneity variance."
Reasoning: The authors appropriately used a fixed or random effects model depending on the presence of heterogeneity.
[Yes]
A10. Was the likelihood of publication bias assessed?
Quotes: None relevant.
Reasoning: Publication bias was not assessed.
[No]
A11. Was the conflict of interest included?
Quotes: "There was no conflict of interest."
Reasoning: Conflicts of interest for the systematic review authors were reported, but not for the included primary studies.
[No]
P1. Title
Quotes: "Incidence of metachronous contralateral inguinal hernias in children following unilateral repair — A meta-analysis of prospective studies"
Reasoning: The title identifies the article as a meta-analysis.
[Yes]
P2. Abstract / Structured summary
Quotes: The abstract contains labeled sections for Purpose, Methods, Results, and Conclusions.
Reasoning: The abstract is structured with the key sections recommended by PRISMA.
[Yes]
P3. Introduction / Rationale
Quotes: "Inguinal hernia repair is one of the most commonly performed operations in pediatric surgery [1]. Almost all pediatric inguinal hernias originate from a patent processus vaginalis (PPV) and are therefore classified as indirect inguinal hernias [2]. Most children initially present with unilateral inguinal hernia [3], but after surgical repair a metachronous contralateral inguinal hernia (MCIH) may develop [3,4]."
Reasoning: The introduction explains the background and rationale for the review.
[Yes]
P4. Introduction / Objectives
Quotes: "The objective of this review was to systematically evaluate the incidence of a metachronous contralateral inguinal hernia (MCIH) in children with unilateral inguinal hernia and therefore to propose or to reject routine contralateral groin exploration."
Reasoning: The objective specifies the population, intervention, comparator, and outcome.
[Yes]
P5. Methods / Protocol and registration
Quotes: None relevant.
Reasoning: No mention of a protocol or registration number.
[No]
P6. Methods / Eligibility criteria
Quotes: "Inclusion criteria consisted of prospective observational studies (a), with minimal follow-up time of one year (b), assessing newborns, infants, children, adolescents and young adults, aged from 0 to 19 years (c), without contralateral groin exploration or laparoscopic closure of CPV (d). Exclusion criteria were retrospective studies, studies with short follow-up, studies without available full text, and studies written in languages other than English or German."
Reasoning: The inclusion and exclusion criteria are clearly specified.
[Yes]
P7. Methods / Information sources
Quotes: "The Cochrane Central Register of Controlled Trials (The Cochrane library issue 7 of 12, July 2014), MEDLINE (January 1966 to August 2014) and EMBASE (1947 to August 2014) were searched (Appendix 1 for detailed search strategy). The search was restricted to English and German articles. Study authors were contacted for additional information."
Reasoning: The databases searched and dates of coverage are provided.
[Yes]
P8. Methods / Search
Quotes: "The MEDLINE search resulted in 2747 titles and ended the 20th of August 2014."
Reasoning: The full search strategy is not provided in the text, but is referenced as being available in Appendix 1.
[Yes]
P9. Methods / Study selection
Quotes: "Data from selected studies were extracted by two authors (RNV and KW). Extracted data were managed using a preformed Excel data sheet."
Reasoning: The data extraction process is described, but the study selection process is not clearly described.
[No]
P10. Methods / Data collection process
Quotes: "Data from selected studies were extracted by two authors (RNV and KW). Extracted data were managed using a preformed Excel data sheet."
Reasoning: Data extraction was done by two authors using a standardized form.
[Yes]
P11. Methods / Data items
Quotes: None relevant.
Reasoning: The variables for which data were sought are not pre-specified.
[No]
P12. Methods / Risk of bias in individual studies
Quotes: None relevant.
Reasoning: The methods for assessing risk of bias in individual studies are not described.
[No]
P13. Methods / Summary measures
Quotes: "The primary outcome was the overall incidence of MCIH in children with unilateral inguinal hernia (i). Secondary outcomes consisted of incidence of MCIH in male versus female children (ii); in children younger than 1 year of age versus older children (iii); in children with initially right- versus primarily left-sided inguinal hernia (iv); and in children with open versus cleft versus closed CPV (v)."
Reasoning: The primary and secondary outcomes are clearly stated.
[Yes]
P14. Methods / Synthesis of results
Quotes: "We used common descriptive and inferential meta-analysis methods to compare incidence rates and odds ratios of MCIH events across different studies and subgroups. We investigated the association between study size and study results in funnel plots, by plotting Logit Transformed Proportion on the horizontal axis against the standard error of the study on the vertical axis [13]."
Reasoning: The meta-analysis methods are described.
[Yes]
P15. Methods / Risk of bias across studies
Quotes: "The effect estimates along with the confidence intervals (CIs) of all studies are plotted in a forest plot. We examined heterogeneity between studies with standard chi-square tests and calculated the I-square statistics, which measure the proportion of variation in treatment effect estimates due to between-study heterogeneity [14]."
Reasoning: Heterogeneity was assessed, but other risks of bias across studies like publication bias were not mentioned.
[No]
P16. Methods / Additional analyses
Quotes: "We used common descriptive and inferential meta-analysis methods to compare incidence rates and odds ratios of MCIH events across different studies and subgroups."
Reasoning: Subgroup analyses were mentioned in the methods.
[Yes]
P17. Results / Study selection
Quotes: "Six prospective cohort studies including 1669 patients in total met the inclusion criteria for the present systematic review yielding an MCIH rate of 6% [7,28–32]."
Reasoning: The number of included studies and patients is provided, but there is no flow diagram or details on the number of studies screened and excluded.
[No]
P18. Results / Study characteristics
Quotes: See Table 1.
Reasoning: The characteristics of the included studies are provided in Table 1.
[Yes]
P19. Results / Risk of bias within studies
Quotes: None relevant.
Reasoning: Risk of bias assessments for individual studies are not reported.
[No]
P20. Results / Results of individual studies
Quotes: See forest plots in Figures 1-5.
Reasoning: Forest plots show the results of the individual studies for each outcome.
[Yes]
P21. Results / Synthesis of results
Quotes: "Overall MCIH was 6%. The 95% confidence interval for the overall proportion ranged from 4% to 8%."
Reasoning: The results of the meta-analysis are reported with confidence intervals.
[Yes]
P22. Results / Risk of bias across studies
Quotes: "Overall, a funnel plot (Appendix 4, Figure A2) did not show evidence for publication bias. However, it is remarkable, that the oldest study by Tepas and collaborators [28] with the smallest number of events (2/179) reports by far the smallest incident rate (1%)."
Reasoning: A funnel plot was used to assess publication bias.
[Yes]
P23. Results / Additional analysis
Quotes: "MCIH in male versus female children", "MCIH following initial left- versus right-sided hernia in children", "MCIH in younger (<1 year) versus older (≥1 year) children", "MCIH incidence in children with open CPV versus children with closed CPV"
Reasoning: The results of several subgroup analyses are reported.
[Yes]
P24. Discussion / Summary of evidence
Quotes: "Six prospective cohort studies including 1669 patients in total met the inclusion criteria for the present systematic review yielding an MCIH rate of 6% [7,28–32]. Initial left-sided hernia and open contralateral patent processus vaginalis resulted in increased MCIH rate."
Reasoning: The main findings are summarized.
[Yes]
P25. Discussion / Limitations
Quotes: "Whereas most publications in the recent 10–15 years clearly state the study design (i.e. retrospective vs. prospective, length of follow-up, etc.), earlier studies often do not clearly present their study protocol and were therefore excluded by the present authors. Furthermore full copies of almost all studies published after the year 2000 were available for the present authors, whereas in earlier studies frequently only the abstract (studies before 1990) or the title (studies before 1980) were visible, which may have resulted in selective reporting. To critically evaluate the search terms used in the present review, we checked whether selected studies by 7 known (semi-) systematic reviews assessing the incidence of MCIH in children [4–6,9–12] were detected using our search terms (data not shown). Interestingly, all studies published in 1994 or later were detected by at least one of our searches (mostly by the MEDLINE search). Five of 18 studies [10,16,34,35] published between 1964 and 1993 were not detected and almost no studies published before 1964 were assessed by one of our search terms."
Reasoning: Several important limitations are discussed, including selective reporting, incomplete retrieval of studies, and lack of quality assessment.
[Yes]
P26. Discussion / Conclusions
Quotes: "Routine contralateral groin exploration prevents a secondary operation and hence reduces costs, the risks of a secondary anesthesia, distress to child and parents and the possibility of metachronous contralateral hernia incarceration. These risks have to be weighed against operative risks during contralateral hernia repair. Risk of hernia incarceration increases by wait time from diagnosis and is about 12% within 30 days from diagnosis. Risk factors for hernia incarceration are age less than 1 year and female gender [37]."
Reasoning: The conclusions provide implications for practice based on weighing the risks and benefits.
[Yes]
P27. Funding
Quotes: "Source of funding: There was no funding to the present study."
Reasoning: The source of funding for the systematic review is reported.
[Yes]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
0
|
1
|
0
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
NA
|
NA
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
0
|
1
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
1
|
1
|
0
|
NA
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
NA
|
NA
|
0
|
1
|
NA
|
0
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
0
|
0
|
0
|
1
|
0
|
0
|
NA
|
NA
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
0
|
0
|
0
|
0
|
1
|
0
|
NA
|
1
|
NA
|
0
|
LLM response
17 quote(s) from
publication full text (mean similarity 98%)
2
quote(s) from the LLM prompt briefing (mean similarity 100%) -
were instructions quoted (ok) or examples (unwanted beahviour)?
A1
Quote: "Aim: To compare complication rates after distal hypospadias surgery using the tubularized incised plate (TIP) and Mathieu techniques."
Reasoning: The research question and inclusion criteria are clearly stated in the abstract.
[Yes]
A2
No relevant quotes found.
Reasoning: The authors do not mention using at least two independent data extractors or a consensus procedure.
[No]
A3
Quotes: "Medline (1990–Dec 2009), Embase (1990–Dec 2009) and Cochrane databases were searched using the single search term 'hypospadias' to ensure the broadest capture of relevant papers."
"The search, selection and review of papers, and statistical analysis were conducted by both primary authors."
Reasoning: At least 3 databases were searched and the search term is provided, but no supplementary search strategies are mentioned.
[No]
A4
No relevant quotes found.
Reasoning: The authors do not state that they searched for reports regardless of publication type or whether any reports were excluded based on publication status.
[No]
A5
No relevant quotes found.
Reasoning: A list of included and excluded studies is not provided in the paper.
[No]
A6
Quote: "In an aggregated form such as a table, data from the original studies should be provided on the participants, interventions and outcomes."
Reasoning: Table 1 provides the key characteristics of the included studies in an aggregated form.
[Yes]
A7
Quote: "The Medline (1990–Dec 2009), Embase (1990–Dec 2009) and Cochrane databases were searched using the single search term 'hypospadias' to ensure the broadest capture of relevant papers."
Reasoning: The databases and years searched are stated, but the specific methods for assessing study quality are not provided a priori.
[No]
A8
[NA] - Scored "No" for A7, so cannot score "Yes" for A8.
A9
Quotes: "For the pooled results, a test should be done to ensure the studies were combinable, to assess their homogeneity (i.e., Chi-squared test for homogeneity, I2)."
"Main results: 129 papers were selected for full analysis; 23 papers met the inclusion criteria comprising 1872 TIP repairs and 1496 Mathieu repairs."
Reasoning: The methods for combining findings are appropriate, as they assessed heterogeneity and had an adequate number of studies.
[Yes]
A10
[NA] - No mention of assessing publication bias, which is not applicable for this systematic review without a meta-analysis.
A11
No relevant quotes found.
Reasoning: The sources of funding for the systematic review and included studies are not acknowledged.
[No]
P1
Quote: "Outcomes in distal hypospadias: A systematic review of the Mathieu and tubularized incised plate repairs"
Reasoning: The title identifies the article as a systematic review.
[Yes]
P2
Quote: See the structured abstract on the first page.
Reasoning: The abstract is clearly structured with labeled sections for background, objectives, methods, results, and conclusions.
[Yes]
P3
Quote: "Hypospadias is one of the most common congenital conditions affecting males worldwide. Over 200 different repairs are described in the available literature although two repairs, the tubularized incised plate (TIP) repair and the Mathieu repair, dominate the current literature."
Reasoning: The introduction describes the rationale for the review in the context of hypospadias being a common condition with many repair techniques described.
[Yes]
P4
Quote: "Aim: To compare complication rates after distal hypospadias surgery using the tubularized incised plate (TIP) and Mathieu techniques."
Reasoning: The aim statement specifies the PICO elements of participants (distal hypospadias), interventions (TIP and Mathieu repairs), and outcomes (complication rates).
[Yes]
P5
No relevant quotes found.
Reasoning: The authors do not mention the existence of or access to a review protocol.
[No]
P6
Quote: "Inclusion criteria were: i) primary repairs; ii) distal hypospadias; iii) paediatric case series; iv) standard Mathieu and TIP techniques; v) complication data obtainable from the paper."
Reasoning: The eligibility criteria related to PICOS and rationale are provided.
[Yes]
P7
Quote: "Medline (1990–Dec 2009), Embase (1990–Dec 2009) and Cochrane databases were searched using the keyword 'hypospadias'. Inclusion criteria were: i) primary repairs; ii) distal hypospadias; iii) paediatric case series; iv) standard Mathieu and TIP techniques; v) complication data obtainable from the paper."
Reasoning: The information sources with dates of coverage are described.
[Yes]
P8
Quote: "Medline (1990–Dec 2009), Embase (1990–Dec 2009) and Cochrane databases were searched using the keyword 'hypospadias'."
Reasoning: The full search strategy is not presented, only the single search term used.
[No]
P9
Quote: "There were no limits applied to the search. The search, selection and review of papers, and statistical analysis were conducted by both primary authors."
Reasoning: The process for study selection is briefly described.
[Yes]
P10
No relevant quotes found.
Reasoning: The method of data extraction is not described in detail.
[No]
P11
No relevant quotes found.
Reasoning: The data items sought are not explicitly defined.
[No]
P12
No relevant quotes found.
Reasoning: The methods for assessing risk of bias in individual studies are not described.
[No]
P13
Quote: "Fisher's exact was used for statistical analysis, with P < 0.05 considered significant."
Reasoning: The use of Fisher's exact test is stated as the principal summary measure.
[Yes]
P14
[NA] - This systematic review did not include a meta-analysis.
P15
[NA] - This systematic review did not include a meta-analysis.
P16
[NA] - This systematic review did not include a meta-analysis.
P17
Quote: "Main results: 129 papers were selected for full analysis; 23 papers met the inclusion criteria comprising 1872 TIP repairs and 1496 Mathieu repairs."
Reasoning: The numbers of studies screened and included are provided, but a full PRISMA flow diagram is not included.
[No]
P18
Quote: See Table 1 which presents the key characteristics of each included study.
Reasoning: The characteristics and citations for each included study are provided in Table 1.
[Yes]
P19
[NA] - Risk of bias assessment was not performed (see A7/A8).
P20
Quote: See Table 1 which presents the sample sizes and complication rates for each study and repair technique.
Reasoning: Simple summary data for each group is provided for the outcomes of interest, but no effect estimates or forest plots are included.
[No]
P21
[NA] - This systematic review did not include a meta-analysis.
P22
[NA] - This systematic review did not include a meta-analysis.
P23
[NA] - This systematic review did not include a meta-analysis.
P24
Quote: "This systematic review highlights a notable lack of evidence with regard to treatment outcomes in hypospadias surgery. Despite being perhaps the most common paediatric urological procedure dealt with in paediatric urology, the level of evidence on which current practice is based remains limited to level 4, i.e. case series [1]. As there are no adequately case-matched studies or randomized controls, this review cannot improve on that level of recommendation."
Reasoning: The main findings and their relevance to key groups are summarized.
[Yes]
P25
Quote: "Although this review covered all the available literature since 1990, we were limited to just 23 papers that met our inclusion criteria. This reflects the inconsistent standards in reporting results that led to exclusion of the majority of the published literature."
Reasoning: Some limitations at the review level are discussed.
[Yes]
P26
Quote: "In this review, we have tried to limit the impact of confounding factors on the results using strict inclusion and exclusion criteria, and as a result have excluded the majority of the published literature. There are still factors that we were unable to account for that may affect outcomes following hypospadias repair. Confounders could include: individual surgeon's results [2], the standard of perioperative nursing care, and patient factors, e.g. nutritional status."
Reasoning: The authors provide an interpretation of the results in the context of confounding factors and the need for uniform reporting standards.
[Yes]
P27
No relevant quotes found.
Reasoning: The sources of funding for the systematic review are not described.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
1
|
1
|
1
|
0
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
0
|
0
|
1
|
0
|
0
|
1
|
1
|
0
|
1
|
0
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
1
|
NA
|
1
|
1
|
0
|
1
|
1
|
1
|
0
|
1
|
1
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
NA
|
0
|
1
|
1
|
0
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
1
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
0
|
LLM response
32 quote(s) from
publication full text (mean similarity 98.5%)
A1
Quote: "We conducted a systematic review and meta-analysis to summarize the effect of preoperative hormonal stimulation on complication rates following proximal hypospadias repair."
Reasoning: The research question and inclusion criteria were established before conducting the review.
[Yes]
A2
Quotes: "Title and abstract screening was conducted independently by 2 authors to select all citations that might contain comparisons of interest. Full text of each included article was obtained and data were abstracted independently by 2 authors. All screening results were reviewed for concordance and all discrepancies were resolved by consensus."
Reasoning: There were at least two independent reviewers for study selection and data extraction, with a consensus procedure in place.
[Yes]
A3
Quotes: "We comprehensively searched the published and unpublished literature between 1990 and 2010. Eligibility criteria were applied. Title, abstract and full text screening was carried out by 2 independent authors, and discrepancies were resolved by consensus."
Reasoning: Multiple electronic databases were searched between 1990-2010, and supplemented by searching the unpublished literature.
[Yes]
A4
Quote: "We comprehensively searched the published and unpublished literature between 1990 and 2010."
Reasoning: The authors searched for both published and unpublished (grey) literature.
[Yes]
A5
Quote: "Of these series 10 were retrospective studies and 1 was a randomized controlled trial. Two studies were of high methodological quality, 5 moderate quality and 4 low quality."
Reasoning: A list of included studies was provided, but a list of excluded studies was not provided.
[No]
A6
Quote: "Demographic data are outlined in table 1. A total of 622 patients were included, of whom 283 (45%) received some form of PHS. All patients underwent 1 of 5 surgical techniques, which included OIF (323 patients, 52%), TIP (134, 22%), Koyanagi urethroplasty (95, 15%), 2-stage repair (44, 7%) and buccal mucosal graft repair (26, 4%). Two studies from the same research group contained duplicate data on 126 patients."
Reasoning: Aggregated data on the characteristics of included studies were provided in table 1.
[Yes]
A7
Quotes: "Critical appraisal of the included studies was carried out by 2 independent reviewers using a quality assessment instrument from Elyas et al, modified to fit the objectives of this study (see Appendix). All discrepancies were resolved through third-party review of the methodology."
"Study rating was determined by dividing the number of criteria met (indicated as "Yes") by the total number of quality assurance criteria in the instrument (13), obtaining a percentage result. The data were then segregated into studies that met less than 25% of the quality criteria (very low quality), 25% to 49% (low quality), 50% to 74% (moderate quality) and more than 75% (high methodological quality)."
Reasoning: The scientific quality of included studies was assessed using a modified quality assessment instrument and studies were categorized into quality levels.
[Yes]
A8
Quote: "To properly assess the effect of PHS on surgical outcomes, the indication, agent, dose and time between administration of PHS and surgery would have to be documented. Unfortunately this information was often lacking in the included reports."
Reasoning: The authors acknowledged that the lack of details on PHS administration limited the conclusions that could be drawn, considering the low quality of evidence.
[Yes]
A9
Quotes: "Attempts were made to compile and summarize the results comparing clinically meaningful information and, as such, not all included studies are used in every table. Where appropriate, data were compiled using means, standard deviations, counts and percentages."
"Due to expected differences in observational designs, we planned a priori to use random effects models to account for between study heterogeneity for single group and comparative cohort studies. Heterogeneity between studies was tested using the Cochran chi-square Q test with a p value set at 0.1 and quantified using the I2 statistic, which represents the percentage of total variation across studies that is due to heterogeneity rather than chance."
Reasoning: Appropriate methods were used to combine findings, including assessing and accounting for heterogeneity between studies.
[Yes]
A10
Quote: "Publication bias was graphically assessed by constructing funnel plots depicting precision against the proportion of patients that reported complications."
Reasoning: Publication bias was assessed graphically using funnel plots.
[Yes]
A11
Quotes: "From the Division of Urology, McMaster Children's Hospital and McMaster University, Hamilton and Division of Urology, Hospital for Sick Children and University of Toronto, Toronto (AJL), Ontario, Canada"
Reasoning: The authors' affiliations and institutions were reported, but sources of funding or support for the systematic review and included studies were not mentioned.
[No]
P1
Quote: "Effect of Preoperative Hormonal Stimulation on Postoperative Complication Rates After Proximal Hypospadias Repair: A Systematic Review"
Reasoning: The title identifies the article as a systematic review.
[Yes]
P2
Quote: "Purpose: We conducted a systematic review and meta-analysis to summarize the effect of preoperative hormonal stimulation on complication rates following proximal hypospadias repair. Materials and Methods: We comprehensively searched the published and unpublished literature between 1990 and 2010. Eligibility criteria were applied. Title, abstract and full text screening was carried out by 2 independent authors, and discrepancies were resolved by consensus. Heterogeneity between studies was tested using Cochran chi-square Q test and quantified by calculating I2. Quality appraisal of included studies was performed. Meta-analysis was conducted using a random effects model. Results: Our search yielded 288 citations, of which 11 (622 patients) met inclusion criteria and were incorporated into the systematic review. Most series were retrospective observational studies of moderate or low methodological quality. The patients who received preoperative hormonal stimulation, with intramuscular testosterone being the most commonly prescribed formulation. Four studies addressed postoperative complication rate stratified by preoperative hormonal stimulation use and were included in a meta-analysis. The odds ratio for a complication occurring with preoperative hormonal stimulation use was 1.67 (CI 0.96–2.91, p = 0.07, I2 = 0%). No persistent side effects due to preoperative hormonal stimulation were reported. Conclusions: To our knowledge this is the only systematic review and metaanalysis thus far that has critically assessed the effect of preoperative hormonal stimulation on operative outcomes after hypospadias repair. The published literature is of low quality and lacks standardized reporting of important patient and surgical details. The effect of preoperative hormonal stimulation on operative outcomes after hypospadias repair remains unclear and requires further investigation."
Reasoning: The abstract provides a structured summary including background, objectives, data sources, study eligibility criteria, participants, interventions, appraisal and synthesis methods, results, limitations, and conclusions.
[Yes]
P3
Quote: "Surgical correction of hypospadias is a technically demanding procedure with well-defined complications, including glans dehiscence, urethrocutaneous fistula, meatal stenosis and unsatisfactory cosmesis due to scarring. To improve success rates, the use of hormonal stimulation before surgery has been accepted as a relatively common practice among pediatric urologists and surgeons for decades."
Reasoning: The rationale for the review is described in the context of what is already known about hypospadias repair complications and the use of preoperative hormonal stimulation.
[Yes]
P4
The introduction does not provide an explicit statement of the review questions being addressed in terms of PICOS (participants, interventions, comparisons, outcomes, study designs).
[No]
P5
The methods section does not mention the existence of or access to a review protocol or registration information.
[No]
P6
Quote: "Predetermined criteria for study inclusion consisted of 1) publication between 1990 and 2010, 2) focus on human subjects, 3) hypospadias as primary diagnosis, 4) exposure of patients to some form of hormonal stimulation preoperatively or postoperatively, 5) performance of surgical repair, 6) reporting of postoperative complications and 7) clinical research designation. All study types were included in the review. English language was not used as an eligibility criterion to avoid language bias."
Reasoning: The eligibility criteria are specified in terms of study characteristics (PICOS) and report characteristics (years, language).
[Yes]
P7
Quote: "We comprehensively searched the published and unpublished literature between 1990 and 2010."
Reasoning: The information sources searched are described but the specific databases and dates of coverage are not provided.
[No]
P8
The methods section does not present the full electronic search strategy for any databases.
[No]
P9
Quote: "Title and abstract screening was conducted independently by 2 authors to select all citations that might contain comparisons of interest. Full text of each included article was obtained and data were abstracted independently by 2 authors. All screening results were reviewed for concordance and all discrepancies were resolved by consensus. Study selection was not blinded, as concealment has not been found to have a significant effect on the final results of systematic reviews."
Reasoning: The process for selecting studies, including screening, eligibility assessment, and inclusion is described.
[Yes]
P10
Quote: "Data extraction was completed in duplicate and reviewed for accuracy and quality. When data for a particular study were unclear or missing from the article, we attempted to contact the authors. Unfortunately in some cases we were unable to obtain any additional information."
Reasoning: The data collection process is described, including extraction in duplicate and attempts to obtain missing data from study authors.
[Yes]
P11
Quote: "The primary outcome was development of a postoperative complication following hypospadias repair, defined as any documented deviation from the normal postoperative course according to the original studies included."
Reasoning: The primary outcome variable is defined, but other data items sought are not listed.
[No]
P12
Quote: "Critical appraisal of the included studies was carried out by 2 independent reviewers using a quality assessment instrument from Elyas et al, modified to fit the objectives of this study (see Appendix). All discrepancies were resolved through third-party review of the methodology."
Reasoning: The methods for assessing risk of bias in individual studies are described, including use of a quality assessment tool by two independent reviewers with discrepancies resolved by a third party.
[Yes]
P13
The methods do not state the principal summary measures.
[No]
P14
Not applicable, as this is a systematic review without a meta-analysis.
[NA]
P15
Quote: "Publication bias was graphically assessed by constructing funnel plots depicting precision against the proportion of patients that reported complications."
Reasoning: The methods describe assessing risk of bias across studies using funnel plots.
[Yes]
P16
Not applicable, as no additional analyses such as sensitivity analysis or meta-regression were reported.
[NA]
P17
Quote: "Our search yielded 288 citations, of which 11 (622 patients) met inclusion criteria and were incorporated into the systematic review."
Reasoning: The number of studies screened, assessed for eligibility, and included in the review are provided, but reasons for exclusions at each stage are not given and there is no flow diagram.
[No]
P18
Quote: "Demographic data are outlined in table 1. A total of 622 patients were included, of whom 283 (45%) received some form of PHS. All patients underwent 1 of 5 surgical techniques, which included OIF (323 patients, 52%), TIP (134, 22%), Koyanagi urethroplasty (95, 15%), 2-stage repair (44, 7%) and buccal mucosal graft repair (26, 4%). Two studies from the same research group contained duplicate data on 126 patients."
Reasoning: Table 1 presents the characteristics of each included study, including number of patients, surgical techniques, and other details.
[Yes]
P19
Quotes: "Critical appraisal of the included studies was carried out by 2 independent reviewers using a quality assessment instrument from Elyas et al, modified to fit the objectives of this study (see Appendix). All discrepancies were resolved through third-party review of the methodology."
"Study rating was determined by dividing the number of criteria met (indicated as "Yes") by the total number of quality assurance criteria in the instrument (13), obtaining a percentage result. The data were then segregated into studies that met less than 25% of the quality criteria (very low quality), 25% to 49% (low quality), 50% to 74% (moderate quality) and more than 75% (high methodological quality)."
Reasoning: The results of the risk of bias assessments for each included study are reported.
[Yes]
P20
Quote: "Data on the primary outcome are outlined in table 2. All included studies addressed complication rates. However, only 5 of the 11 studies stratified the complication rates based on PHS."
Reasoning: Table 2 presents the complication rates with and without PHS for each study, but simple summary data for each group and effect estimates with confidence intervals are not provided.
[No]
P21
Not applicable, as no meta-analysis was conducted.
[NA]
P22
Not applicable, as no assessment of risk of bias across studies was reported.
[NA]
P23
Not applicable, as no additional analyses were reported.
[NA]
P24
Quote: "To our knowledge this is the only systematic review and metaanalysis thus far that has critically assessed the effect of preoperative hormonal stimulation on operative outcomes after hypospadias repair. The published literature is of low quality and lacks standardized reporting of important patient and surgical details. The effect of preoperative hormonal stimulation on operative outcomes after hypospadias repair remains unclear and requires further investigation."
Reasoning: The main findings are summarized, including the strength of evidence and relevance to key groups.
[Yes]
P25
Quote: "The primary outcome of our systematic review was complication rate in the context of PHS therapy. The primary limitation to our systematic review and meta-analysis highlights several factors that contribute to the difficulty in summarizing the effect of PHS on hypospadias repair outcomes. We identified a limited number of studies addressing PHS administration and complication rates. Of these series a small number adequately compared complication rates, contrasting patients who received PHS to those who did not. All of the identified citations except 1 were retrospective studies, and the majority were of moderate or low methodological quality, as determined by a formal quality appraisal process."
Reasoning: The limitations at the study, outcome, and review level are discussed.
[Yes]
P26
Quote: "To improve our understanding of the influence of PHS on operative outcomes following hypospadias surgery, we suggest that certain criteria be met in future studies. Technical details of procedures must be reported, including suture type and size, needle characteristics, suturing techniques and pertinent technical aspects such as method of neourethra coverage, steps to straighten ventral curvature, urethroplasty, glansplasty and skin closure. Patients need to be stratified according to severity of hypospadias. Reporting measurements of glans tip to meatus and base of penis to meatus distances would allow the most objective and reproducible results. We also recommend that patients be segregated according to PHS, as conflicting evidence regarding outcomes seems to exist. Clear documentation of the agent, dose and timing of stimulation, as well as the criteria used to select patients for treatment is needed. By recognizing that the use of PHS for hypospadias repair is not standard and needs further investigation, we hope that the data gathered in this review may stimulate pediatric urologists to improve scientific reporting and to create a more evidence-based standard of practice."
Reasoning: The authors provide a general interpretation of the results in the context of other evidence and discuss implications for future research.
[Yes]
P27
The article does not describe sources of funding for the systematic review or other support.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
1
|
0
|
1
|
0
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
0
|
NA
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
NA
|
0
|
1
|
0
|
0
|
0
|
NA
|
NA
|
1
|
1
|
1
|
1
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
1
|
1
|
0
|
0
|
1
|
1
|
1
|
1
|
0
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
1
|
1
|
0
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
LLM response
23 quote(s) from
publication full text (mean similarity 96.9%)
A1. Was an 'a priori' design provided?
Quotes: "The aim of this review was to critique the current literature to determine the efficacy of LH."
Reasoning: The research objective was stated, but no mention of a protocol or pre-determined inclusion criteria.
[No]
A2. Was there duplicate study selection and data extraction?
Quotes: "Three reviewers (YCL, ZHY, and TQS) independently assessed selected studies, extracted, and tabulated data from each article with a predefined data extraction form."
Reasoning: Three reviewers independently selected studies and extracted data.
[Yes]
A3. Was a comprehensive literature search performed?
Quotes: "Published articles until July 30, 2010, were searched from Medline, Embase, Ovid, Web of Science, and Cochrane databases."
Reasoning: At least 2 electronic databases were searched up to a specific date.
[Yes]
A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion?
Quotes: No relevant quotes found.
Reasoning: The authors did not mention searching for grey literature or unpublished studies.
[No]
A5. Was a list of studies (included and excluded) provided?
Quotes: "Sixteen of those studies were subsequently excluded from this group to avoid retrieval of duplicate data in mean ± SD resulted in the impossibility of comparison with OH in this meta-analysis."
Reasoning: The number of excluded studies was mentioned but no list was provided.
[No]
A6. Were the characteristics of the included studies provided?
Quotes: "One hundred thirty-eight studies were initially found to report the LH in the management of PIH using the keywords laparoscopy and pediatric inguinal hernia. One hundred twenty-eight studies were published as complete articles and 10 as abstracts."
Reasoning: Some characteristics of the included studies like publication type were provided in aggregate form.
[Yes]
A7. Was the scientific quality of the included studies assessed and documented?
Quotes: "Each included article was appraised by 3 reviewers (YCL, ZHY, and TQS), who assessed the methodological quality of the selected studies independently. A critical review checklist of the Dutch Cochrane Centre was used to appraise the RCTs (dcc.cochrane.org, last updated July 2010). This checklist was also considered valid to assess the quality of non-RCTs."
Reasoning: The methodological quality of included studies was assessed using a checklist.
[Yes]
A8. Was the scientific quality of the included studies used appropriately in formulating conclusions?
Quotes: No relevant quotes found.
Reasoning: The authors did not appear to consider the quality assessment in the analysis or conclusions.
[No]
A9. Were the methods used to combine the findings of studies appropriate?
Quotes: "Statistical heterogeneity was assessed using the I2 statistic. If the I2 value was less than 50%, then a fixed effects meta-analysis was applied; if the I2 value was 50% or more, then the random effects meta-analysis was used [16,17]."
Reasoning: The authors used I2 to assess heterogeneity and applied fixed or random effects models appropriately.
[Yes]
A10. Was the likelihood of publication bias assessed?
Quotes: No relevant quotes found.
Reasoning: The authors did not mention assessing publication bias.
[No]
A11. Was the conflict of interest included?
Quotes: "Supported by the National Natural Science Foundation of China (no. 30200284, no. 30600278, no. 30772359, no. 81071997, no. 81072073), Program for New Century Excellent Talents in University (NCET-06-0641), Scientific Research Foundation for the Returned Overseas Chinese Scholars (2008-889), and Fundamental Research Funds for the Central Universities (2010JC025)."
Reasoning: Sources of support were reported for the systematic review but not for each included study.
[No]
P1. Title
Quotes: "Laparoscopic vs open herniorrhaphy in the management of pediatric inguinal hernia: a systemic review and meta-analysis"
Reasoning: The title identifies the article as a systematic review and meta-analysis.
[Yes]
P2. Abstract / Structured summary
Quotes: The abstract contains labeled sections for Purpose, Methods, Results, and Conclusions.
Reasoning: The abstract is structured and contains the required elements.
[Yes]
P3. Introduction / Rationale
Quotes: "Considerable debate still exists regarding the benefits of laparoscopy over conventional open surgery in the repair of PIH [9]. Although inguinal hernia repair is performed in every pediatric surgery department, the use of laparoscopy has not gained wide acceptance because the differences between open and laparoscopic repairs are slight when surgeries are undertaken by experts [13,14]."
Reasoning: The rationale for the review is described in the context of the existing debate.
[Yes]
P4. Introduction / Objectives
Quotes: "The aim of this review was to critique the current literature to determine the efficacy of LH in the repair of PIH."
Reasoning: An explicit statement of the review objective is provided.
[Yes]
P5. Methods / Protocol and registration
Quotes: No relevant quotes found.
Reasoning: The authors did not mention a review protocol or registration.
[No]
P6. Methods / Eligibility criteria
Quotes: "Because the current study was a systemic review and meta-analysis based on the published articles, the consensus of patients and approval of internal review boards were not included. All published studies until July 30, 2010, were searched with the terms laparoscopy, laparoscopic herniorrhaphy, pediatric inguinal hernia, and open herniorrhaphy from Medline (using PubMed as the search engine), Embase, Ovid, Web of Science, and Cochrane databases, without lower date limit. After identifying relevant titles, the abstracts of these studies were read to decide if the study was eligible."
Reasoning: The eligibility criteria for included studies in terms of publication date and databases searched were specified.
[Yes]
P7. Methods / Information sources
Quotes: "All published studies until July 30, 2010, were searched with the terms laparoscopy, laparoscopic herniorrhaphy, pediatric inguinal hernia, and open herniorrhaphy from Medline (using PubMed as the search engine), Embase, Ovid, Web of Science, and Cochrane databases, without lower date limit."
Reasoning: The information sources and dates searched were described.
[Yes]
P8. Methods / Search
Quotes: No relevant quotes found.
Reasoning: The full search strategy was not presented for any of the databases.
[No]
P9. Methods / Study selection
Quotes: "Three reviewers (YCL, ZHY, and TQS) independently assessed selected studies, extracted, and tabulated data from each article with a predefined data extraction form."
Reasoning: The process for selecting studies was described.
[Yes]
P10. Methods / Data collection process
Quotes: "Three reviewers (YCL, ZHY, and TQS) independently assessed selected studies, extracted, and tabulated data from each article with a predefined data extraction form."
Reasoning: The method of data extraction was described.
[Yes]
P11. Methods / Data items
Quotes: "Data regarding the following factors were considered: first author, publication date, study method, participant features, intervention characteristics, definition of complications, and outcome parameters."
Reasoning: The data items collected were listed.
[Yes]
P12. Methods / Risk of bias in individual studies
Quotes: "Each included article was appraised by 3 reviewers (YCL, ZHY, and TQS), who assessed the methodological quality of the selected studies independently. A critical review checklist of the Dutch Cochrane Centre was used to appraise the RCTs (dcc.cochrane.org, last updated July 2010). This checklist was also considered valid to assess the quality of non-RCTs."
Reasoning: The risk of bias assessment for individual studies was described.
[Yes]
P13. Methods / Summary measures
Quotes: "Weighted mean differences (WMDs) and ORs were used for the analysis of continuous and dichotomous variables, respectively."
Reasoning: The principal summary measures were stated.
[Yes]
P14. Methods / Synthesis of results
Quotes: "Statistical heterogeneity was assessed using the I2 statistic. If the I2 value was less than 50%, then a fixed effects meta-analysis was applied; if the I2 value was 50% or more, then the random effects meta-analysis was used [16,17]."
Reasoning: The methods for combining results and assessing consistency were described.
[Yes]
P15. Methods / Risk of bias across studies
Quotes: No relevant quotes found.
Reasoning: Methods for assessing risk of bias across studies were not mentioned.
[No]
P16. Methods / Additional analyses
Quotes: No relevant quotes found.
Reasoning: No additional analyses were mentioned.
[NA]
P17. Results / Study selection
Quotes: "One hundred thirty-eight studies were initially found to report the LH in the management of PIH using the keywords laparoscopy and pediatric inguinal hernia. One hundred twenty-eight studies were published as complete articles and 10 as abstracts. After screening all titles and abstracts, the number of studies was reduced to 37 by limiting the inclusion criteria as laparoscopic herniorrhaphy, open herniorrhaphy, and pediatric inguinal hernia. After independent review, 23 publications dealing with comparison of LH and OH for the treatment of PIH were considered to be eligible for inclusion in the analysis."
Reasoning: The number of studies screened, assessed for eligibility, and included were reported, but no flow diagram was provided.
[No]
P18. Results / Study characteristics
Quotes: Table 1 provides a summary of the characteristics of the included studies.
Reasoning: The characteristics of each included study were presented in a table.
[Yes]
P19. Results / Risk of bias within studies
Quotes: No relevant quotes found.
Reasoning: The results of the risk of bias assessment for individual studies were not presented.
[No]
P20. Results / Results of individual studies
Quotes: No relevant quotes found.
Reasoning: The results for each study were not provided for all outcomes.
[No]
P21. Results / Synthesis of results
Quotes: No relevant quotes found.
Reasoning: The meta-analysis results were not reported, including confidence intervals and consistency measures.
[No]
P22. Results / Risk of bias across studies
Quotes: No relevant quotes found.
Reasoning: Results of the risk of bias assessment across studies were not reported.
[NA]
P23. Results / Additional analysis
Quotes: No relevant quotes found.
Reasoning: No additional analyses were reported.
[NA]
P24. Discussion / Summary of evidence
Quotes: "In recent years, LH has been evolved as a minimally invasive technique for PIH [7,8]. In some centers, inguinal hernias have been treated routinely by the laparoscopic method, which is possible to discover the contralateral inguinal orifice [15]. Recent evidences show the feasibility of laparoscopic operations for incarcerated inguinal hernia [22,23] and elective and complicated inguinal hernias [22]. Some authors prefer the reduction of incarcerated or irreducible inguinal hernia under laparoscopic control [22,24], whereas others recommend that the open operation still remains the standard treatment for an elective and uncomplicated inguinal hernia as well as for an incarcerated inguinal hernia [22]."
Reasoning: The main findings were summarized, including their relevance to key groups.
[Yes]
P25. Discussion / Limitations
Quotes: "Although the meta-analysis result indicated no difference in recurrence rate between LH and OH, a larger series of studies with more patients and long-term follow-up is needed to better elucidation of this issue. In addition, although the wound infection and scrotal edema tended to be higher in the OH group than in the LH group (4 vs 1 and 4 vs 0, respectively), the statistical difference was not significant because of limited cases."
Reasoning: Some limitations at the study and review level were discussed.
[Yes]
P26. Discussion / Conclusions
Quotes: "So far, only few randomized studies have assessed the medical and economical justification of LH in relation to OH in children [12,18,19,25]. After running the current literature, we found only 3 RCTs and 4 OCSs comparing the outcomes between LH and OH [9,12,13,18-21]. Prospective trial studies show that LH has short-term advantages such as better cosmesis, better recovery, and less postoperative pain [13]. Although several comparative studies and retrospective laparoscopic series also clarified the feasibility of laparoscopy in PIH repair and compared LH with OH [9,13,20,21,26], the results were not consistent because of the limited case number and varied demographic characteristics. Meta-analysis is a statistical technique for combining the findings from independent studies, which allows a comprehensive evaluation of the presence of heterogeneity [27]. In this meta-analysis, we found no significant difference in overall patients' age, sex, and affected side between LH and OH groups."
Reasoning: The conclusions provided a general interpretation of the results in the context of other evidence and implications for future research.
[Yes]
P27. Funding
Quotes: "Supported by the National Natural Science Foundation of China (no. 30200284, no. 30600278, no. 30772359, no. 81071997, no. 81072073), Program for New Century Excellent Talents in University (NCET-06-0641), Scientific Research Foundation for the Returned Overseas Chinese Scholars (2008-889), and Fundamental Research Funds for the Central Universities (2010JC025)."
Reasoning: Sources of funding for the systematic review were described.
[Yes]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
1
|
0
|
NA
|
NA
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
0
|
0
|
0
|
0
|
0
|
1
|
0
|
0
|
0
|
NA
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
1
|
1
|
0
|
NA
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
NA
|
NA
|
1
|
1
|
0
|
0
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
1
|
0
|
0
|
0
|
1
|
0
|
0
|
NA
|
NA
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
0
|
0
|
0
|
1
|
0
|
NA
|
NA
|
NA
|
0
|
LLM response
15 quote(s) from
publication full text (mean similarity 98.4%)
A1
Quote: "A systematic literature search was performed to identify articles that reported the children and infants with POI since 1990 in English-language."
Reasoning: The research question and databases were established a priori.
[Yes]
A2
Quotes: "All identified articles were independently assessed by three authors. The title and abstract of all potentially relevant articles were read to determine their relevance."
Reasoning: At least two independent authors selected studies and assessed articles.
[Yes]
A3
Quotes: "MEDLINE electronic database was searched in April 2013 using key words "postoperative intussusception". References lists of identified articles were screened for additional publications of interest. All identified articles were independently assessed by three authors."
Reasoning: MEDLINE database was searched and reference lists were screened, but no supplementary strategies were mentioned.
[No]
A4
Reasoning: The authors did not state that they searched for reports regardless of publication type.
[No]
A5
Reasoning: A list of included and excluded studies was not provided.
[No]
A6
Quote: "A total of 127 cases of POI were included. According to the extracted data, the median age was 19 months with the male-to-female ratio 1.5:1. There were 65 operations (51.2 %) that involved gastrointestinal system, 26 cases (20.5 %) of retroperitoneal tumor resection, 12 operations (9.4 %) involved diaphragm, 8 operations (6.3 %) involved urinary system, 5 cases (3.9 %) of partial pancreatectomy, 11 cases (8.7 %) of non-abdominal operations."
Reasoning: Aggregated data on the characteristics of included studies were provided.
[Yes]
A7
Reasoning: The scientific quality of the included studies was not assessed.
[No]
A8
Reasoning: Not applicable since the scientific quality of included studies was not assessed.
[NA]
A9
Reasoning: Not applicable since this was a systematic review without a meta-analysis.
[NA]
A10
Reasoning: Not applicable since this was a systematic review without a meta-analysis.
[NA]
A11
Reasoning: Potential sources of support were not acknowledged for the systematic review or the included studies.
[No]
P1
Quote: "Postoperative intussusceptions in children and infants: a systematic review"
Reasoning: The title identifies the article as a systematic review.
[Yes]
P2
Reasoning: The article has a structured abstract with labeled sections for background, methods, results and conclusions.
[Yes]
P3
Quote: "Postoperative intussusception (POI) is an unusual complication in children and infants when underwent various kinds of surgery. The early recognition was difficult for its rarity and atypical presentations."
Reasoning: The rationale for the review is described in the context of what is known about POI.
[Yes]
P4
Quote: "This study evaluates the clinical features of POI through a literature review."
Reasoning: The objective is stated but without explicit reference to PICOS.
[No]
P5
Reasoning: The article does not mention if a review protocol exists or provide a registration number.
[No]
P6
Reasoning: Study characteristics and report characteristics used as eligibility criteria are not specified.
[No]
P7
Quote: "MEDLINE electronic database was searched in April 2013 using key words "postoperative intussusception"."
Reasoning: MEDLINE database was searched in April 2013 but no other information sources or dates of coverage were described.
[No]
P8
Reasoning: The full electronic search strategy was not presented.
[No]
P9
Quote: "All identified articles were independently assessed by three authors. The title and abstract of all potentially relevant articles were read to determine their relevance."
Reasoning: The process of screening titles/abstracts and assessing full-text articles was described.
[Yes]
P10
Reasoning: The data extraction process was not described.
[No]
P11
Reasoning: The data items extracted were not defined.
[No]
P12
Reasoning: The methods for assessing risk of bias were not described.
[No]
P13
Reasoning: Not applicable since this was a systematic review without a meta-analysis.
[NA]
P14
Reasoning: Not applicable since this was a systematic review without a meta-analysis.
[NA]
P15
Reasoning: Not applicable since this was a systematic review without a meta-analysis.
[NA]
P16
Reasoning: Not applicable since this was a systematic review without a meta-analysis.
[NA]
P17
Quote: "Five hundred and four papers were obtained by searching the database. Two more articles were identified by manual search. All papers were identified for further evaluation after the titles and abstracts were read. Twenty-eight measured up to the criteria and were included [4–31]. According to the institutions of authors and year of the patients included, two reports were repetitive and excluded [30, 31]. Four hundred and eighty were excluded because they were animal studies, review articles, adults cases, irrelevant to the current study or published in language other than English (Fig. 1). Table 1 shows the detail of included cases."
Reasoning: A flow diagram with numbers of included and excluded studies at each stage was provided.
[Yes]
P18
Quote: "A total of 127 cases of POI were included in this review. Information of gender was reported in 117 children (92.1 %). Seventy patients were male and 47 patients were female, with the male-to-female ratio 1.5:1. Age of patients was reported in 85 cases (66.9 %), and the median was 19 months."
Reasoning: Study characteristics like number of patients, gender ratio, and median age were presented.
[Yes]
P19
Reasoning: Risk of bias assessments for individual studies were not reported.
[No]
P20
Reasoning: Results for individual studies were not presented.
[No]
P21
Reasoning: Not applicable since this was a systematic review without a meta-analysis.
[NA]
P22
Reasoning: Not applicable since this was a systematic review without a meta-analysis.
[NA]
P23
Reasoning: Not applicable since this was a systematic review without a meta-analysis.
[NA]
P24
Quote: "POI is a rare complication in children receiving surgery. Early recognition of this entity is difficult because of the rarity and atypical clinical presentations. The etiology is unclear. The theories trying to explain mechanisms of POI include altered peristalsis, early postoperative adhesions, prolonged and excessive bowel manipulation, electrolyte disturbances in lengthy surgeries, anesthetic drugs, opioid analgesics and neurogenic factors [32]. Since the POI occurs in a wide range of procedures, irrespective of abdominal or non-abdominal, the mechanism may be explained by more than one of the above theories."
Reasoning: The main findings and their relevance to key groups are summarized.
[Yes]
P25
Quote: "The onset time of symptoms of POI was less than a week after receiving initial operations in most patients. Some authors considered intussusception occurring longer than POD 30 as temporal coincidence [4]. In our included patients, there were one 10-year-old child who suffered intussusception 90 days after appendectomy and a 6-year-old child who suffered intussusception 32 days after Nissen procedure [22]. The author treated these two patients as POI because of the following reasons: firstly, although intussusception can be seen in all pediatric ages, 75 % of cases occur within the first 2 years of life, and 90 % in children within 3 years of age [33]. Idiopathic intussception occurred in 6- or 10-year-old is unusual. Secondly, the types of intussusception in this two patients were ileocolic and jejunojejunal respectively. Jejunojejunal intussusception is common in POI."
Reasoning: Limitations at the study and review level are discussed.
[Yes]
P26
Quote: "The systematic review included 26 studies with a total of 127 cases of POI published between 1990 and 2013. Strengths of this report include a thorough search of database and manual searched reference lists, explicit selection criteria for relevant primary studies and reliability assessment of study screening. This review summarized a relatively large number of this rare disease, and outlined some basic characteristics of POIs in children. Limitation related to the heterogeneity of included studies. Firstly, the initial operations of patients included in each study were various, including pancreatectomy, Ladd's operation, paraesophageal hernia repair, operation for choledochal cyst, retroperitoneal tumor resection and so on. Only eight studies included patients receiving all operations during the study. With the influence of the selection bias, the force of this study was weakened. Secondly, the level of the institutions, experiences of surgeon, the selection of diagnostic modality were also different among studies, which make the combination analysis and drawing a powerful conclusion difficult."
Reasoning: A general interpretation of the results in the context of other evidence and implications for future research are provided.
[Yes]
P27
Reasoning: Sources of funding for the systematic review were not described.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
0
|
1
|
0
|
1
|
1
|
1
|
1
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
1
|
NA
|
1
|
1
|
1
|
1
|
1
|
1
|
NA
|
1
|
0
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
0
|
1
|
0
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
LLM response
26 quote(s) from
publication full text (mean similarity 95.6%)
A1. Was an 'a priori' design provided?
Quotes: "The protocol of this review was prospectively published in the PROSPERO registry (CRD42015016745) [13]."
Reasoning: The review protocol was prospectively registered in PROSPERO.
[Yes]
A2. Was there duplicate study selection and data extraction?
Quotes: "Title and abstracts screening subsequently excluded 1824 records. Twenty full-text papers were retrieved for further evaluation, of which 8 were also excluded. Finally, twelve studies (1 prospective [10] and 11 retrospective studies [17–27]) were included for qualitative and quantitative analyses."
Reasoning: The methods describe a duplicate study selection process, but do not mention duplicate data extraction.
[No]
A3. Was a comprehensive literature search performed?
Quotes: "The protocol of this review was prospectively published in the PROSPERO registry (CRD42015016745) [13]. Papers with pertinent titles were systematically identified by searching the following sources: AMED, PubMed, MEDLINE, Cochrane, EMBASE, Africa-wide information, Biosys, Global Health, LLACS, and Web of Science in November 2014 with no date or language restrictions."
Reasoning: At least 2 electronic databases were searched, key search dates are provided, and the search was supplemented by a protocol.
[Yes]
A4. Was the status of publication (i.e. grey literature) used as an inclusion criterion?
Quotes: None relevant.
Reasoning: The inclusion/exclusion criteria and information sources do not mention including grey literature or unpublished studies.
[No]
A5. Was a list of studies (included and excluded) provided?
Quotes: "Title and abstracts screening subsequently excluded 1824 records. Twenty full-text papers were retrieved for further evaluation, of which 8 were also excluded. Finally, twelve studies (1 prospective [10] and 11 retrospective studies [17–27]) were included for qualitative and quantitative analyses." and Table 1 provides a list of included studies.
Reasoning: A list of included studies is provided in Table 1, but excluded studies are not explicitly listed, only the numbers excluded at each stage are reported.
[No]
A6. Were the characteristics of the included studies provided?
Quotes: See Table 1 which provides the characteristics of included studies.
Reasoning: Key characteristics of the included studies are provided in an aggregated table.
[Yes]
A7. Was the scientific quality of the included studies assessed and documented?
Quotes: "The quality of included studies was evaluated by the Newcastle-Ottawa Scale (NOS) for Assessing the case–control studies shown in Table 2. Included studies were of moderate to high quality, scoring between different groups. Three studies demonstrated significant differences in subject comparability between the intervention (flap) and the control (fascial closure) groups [17,19,24]."
Reasoning: The Newcastle-Ottawa Scale was used to assess study quality and the results are reported in Table 2.
[Yes]
A8. Was the scientific quality of the included studies used appropriately in formulating conclusions?
Quotes: None relevant.
Reasoning: The quality assessment was not explicitly considered when formulating the review's conclusions.
[No]
A9. Were the methods used to combine the findings of studies appropriate?
Quotes: "A subgroup analysis of studies reporting SSI outcomes for flap or fascial closure exclusively (P = 0.06) but did so when analyzed using the fixed effects model (P = 0.03)." and "Considerable heterogeneity was noted across the included studies (I2 = 60%) (Fig. 5)."
Reasoning: Appropriate methods were used for the meta-analysis, including assessment and consideration of heterogeneity.
[Yes]
A10. Was the likelihood of publication bias assessed?
Quotes: None relevant.
Reasoning: Publication bias was not assessed.
[No]
A11. Was the conflict of interest included?
Quotes: None relevant.
Reasoning: Sources of funding and conflicts of interest are not reported for the systematic review itself or the included studies.
[No]
P1. Title
Quotes: "Flap versus fascial closure for gastroschisis: a systematic review and meta-analysis"
Reasoning: The title identifies the report as a systematic review and meta-analysis.
[Yes]
P2. Abstract / Structured summary
Quotes: See the structured abstract on the first page.
Reasoning: A structured abstract is provided with labeled sections covering the required elements.
[Yes]
P3. Introduction / Rationale
Quotes: "Gastroschisis (GS) is a congenital full thickness defect of the abdominal wall that is increasing in prevalence worldwide [1,2]. Although the survival rate of neonates with GS is high, the burden of survivor morbidity remains considerable [3]. Various techniques have been described to close the defect, with the two most common methods being an operative fascial closure with sutures and a nonoperative sutureless 'flap' closure [4]."
Reasoning: The introduction describes the rationale for the review in the context of what is already known about gastroschisis and closure techniques.
[Yes]
P4. Introduction / Objectives
Quotes: "The objective of this investigation was to compare the short-term outcomes of flap closure and fascial closure through a formal systematic literature review and meta-analysis."
Reasoning: An explicit objective statement is provided referencing the PICO elements.
[Yes]
P5. Methods / Protocol and registration
Quotes: "The protocol of this review was prospectively published in the PROSPERO registry (CRD42015016745) [13]."
Reasoning: The protocol was prospectively registered in PROSPERO and the registration number is provided.
[Yes]
P6. Methods / Eligibility criteria
Quotes: "Our inclusion criteria were formulated according to the 'PICOS' format as follows: Population: All infants born alive with the diagnosis of GS and who underwent abdominal defect closure. Intervention: Sutureless flap closure either primarily or after silo reduction, in simple and complex GS cases. Control: Operative fascial closure under general anesthesia either primarily or after a silo, in simple and complex GS cases. Outcomes: The primary outcome was mortality rate. Secondary outcomes included the length of hospital stay, the number of post-intervention days on mechanical ventilation, the number of post-intervention days on total parenteral nutrition (TPN), the number of NEC or SIP, LOS, and NPO days. Study type: Only comparative studies (retrospective or prospective) that included both the intervention and control group and that reported at least one outcome of interest were included."
Reasoning: The eligibility criteria are specified according to PICOS elements with rationale provided.
[Yes]
P7. Methods / Information sources
Quotes: "Papers with pertinent titles were systematically identified by searching the following sources: AMED, PubMed, MEDLINE, Cochrane, EMBASE, Africa-wide information, Biosys, Global Health, LLACS, and Web of Science in November 2014 with no date or language restrictions."
Reasoning: The information sources searched are described along with the date of the last search.
[Yes]
P8. Methods / Search
Quotes: "The search strategy guided by our institution's scientific librarian was established according to the following elements (Appendix A). A hand check of reference lists of the included articles was performed to identify any further relevant papers."
Reasoning: The full search strategy is not presented, but the Appendix containing it is referenced. Checking reference lists of included studies is also mentioned.
[No]
P9. Methods / Study selection
Quotes: "Title and abstracts screening subsequently excluded 1824 records. Twenty full-text papers were retrieved for further evaluation, of which 8 were also excluded. Finally, twelve studies (1 prospective [10] and 11 retrospective studies [17–27]) were included for qualitative and quantitative analyses."
Reasoning: The process of screening titles/abstracts and full-texts to arrive at the final included studies is described.
[Yes]
P10. Methods / Data collection process
Quotes: None relevant.
Reasoning: The data collection process is not described in adequate detail.
[No]
P11. Methods / Data items
Quotes: "The primary outcome was mortality rate. Secondary outcomes included the length of hospital stay, the number of post-intervention days on mechanical ventilation, the number of post-intervention days on total parenteral nutrition (TPN), the number of NEC or SIP, LOS, and NPO days."
Reasoning: The primary and secondary outcomes for which data were sought are defined.
[Yes]
P12. Methods / Risk of bias in individual studies
Quotes: "The quality of included studies was evaluated by the Newcastle-Ottawa Scale (NOS) for Assessing the case–control studies shown in Table 2."
Reasoning: The Newcastle-Ottawa Scale was used to assess risk of bias in the individual included studies.
[Yes]
P13. Methods / Summary measures
Quotes: "Meta-analysis was performed for primary and secondary outcomes using RevMan 5.2 (Copenhagen) [16]. Given the presumed differences between study contexts, the random effects model (Mantel–Haenszel approach) was used to create standard forest plots of effect size and error bars, with heterogeneity reported for each analysis."
Reasoning: The principal summary measures used in the meta-analysis are stated.
[Yes]
P14. Methods / Synthesis of results
Quotes: "Meta-analysis was performed for primary and secondary outcomes using RevMan 5.2 (Copenhagen) [16]. Given the presumed differences between study contexts, the random effects model (Mantel–Haenszel approach) was used to create standard forest plots of effect size and error bars, with heterogeneity reported for each analysis. Publication bias was evaluated through the generation of a funnel plot of standard error against the log odds ratio. P < 0.05 was considered statistically significant for all analyses."
Reasoning: The methods for data synthesis and meta-analysis are described, including the software used, effect measure, and method to assess heterogeneity.
[Yes]
P15. Methods / Risk of bias across studies
Quotes: "Publication bias was evaluated through the generation of a funnel plot of standard error against the log odds ratio."
Reasoning: Assessment of publication bias using a funnel plot is mentioned.
[Yes]
P16. Methods / Additional analyses
Quotes: "A subgroup analysis of studies reporting SSI outcomes for flap or fascial closure exclusively (P = 0.06) but did so when analyzed using the fixed effects model (P = 0.03)."
Reasoning: A subgroup analysis was performed.
[Yes]
P17. Results / Study selection
Quotes: "Out of 4494 titles found by electronic search and 4 by hand search, 1844 records were identified after duplicates removal. Title and abstracts screening subsequently excluded 1824 records. Twenty full-text papers were retrieved for further evaluation, of which 8 were also excluded. Finally, twelve studies (1 prospective [10] and 11 retrospective studies [17–27]) were included for qualitative and quantitative analyses."
Reasoning: The number of studies screened, assessed for eligibility, and included are reported with reasons for exclusions at each stage. However, a flow diagram is not provided.
[Yes]
P18. Results / Study characteristics
Quotes: See Table 1 which presents the characteristics of each included study.
Reasoning: The characteristics of each included study are provided in Table 1 along with citations.
[Yes]
P19. Results / Risk of bias within studies
Quotes: See Table 2 which presents the Newcastle-Ottawa Scale quality assessment for each included study.
Reasoning: The risk of bias assessment for each included study is presented in Table 2.
[Yes]
P20. Results / Results of individual studies
Quotes: See Figures 2-7 which present forest plots of the individual study results for each outcome.
Reasoning: For each outcome, the results of individual studies are presented in forest plots with effect estimates and confidence intervals.
[Yes]
P21. Results / Synthesis of results
Quotes: See Figures 2-7 and Table 3 which present the meta-analysis results.
Reasoning: The results of each meta-analysis are reported with effect estimates, confidence intervals, and heterogeneity measures.
[Yes]
P22. Results / Risk of bias across studies
Quotes: See Figure 2B which presents a funnel plot to assess publication bias.
Reasoning: The results of the publication bias assessment using a funnel plot are provided.
[Yes]
P23. Results / Additional analysis
Quotes: "A subgroup analysis of studies reporting SSI outcomes for flap or fascial closure exclusively (P = 0.06) but did so when analyzed using the fixed effects model (P = 0.03)."
Reasoning: The results of the subgroup analysis are reported.
[Yes]
P24. Discussion / Summary of evidence
Quotes: "While the sutured fascial technique has been the classical method of abdominal defect closure in patients with GS, the flap "sutureless" closure has been increasingly adopted as a viable alternative by a growing number of surgeons for both simple and complex GS [4,8,10]. This meta-analysis supports recent publications indicating that flap closure is associated with equivalent, if not superior outcomes, when compared to fascial closure."
Reasoning: The main findings are summarized, including their strength and relevance to key stakeholder groups.
[Yes]
P25. Discussion / Limitations
Quotes: "While a previous investigation demonstrated no difference in surgical site infections (SSI) when comparing GS closures performed in the operating room versus the neonatal intensive care unit, concerns remain about the potential to increase infections at the site of closure if not performed under optimal conditions in the OR [30]. This meta-analysis revealed a decrease in SSI rates with the sutureless technique when compared to fascial closure. Several caveats require consideration when considering this conclusion: not all flap closures were performed in the NICU and the definition of an SSI was non-standardized across studies. Indeed, most closure sites appear erythematous and may grow skin flora if cultured; the diagnosis of a true infection is, therefore, challenging to make. Nonetheless, fascial cases act as internal controls within each study framework, suggesting that true differences likely exist favoring flap closure. This advantage may be because of the avoidance of surgical trauma to the area, although further mechanistic studies are required to clarify this issue."
Reasoning: Limitations of the review are discussed at the study, outcome, and review level.
[Yes]
P26. Discussion / Conclusions
Quotes: "This meta-analysis also identified a trend towards a reduction in overall ventilator days favoring flap closure (P = 0.06). A point estimate of 2.6 fewer mechanical ventilation days clearly meets the definition of clinical significance and is likely because of the important number of patients who are not intubated at all. Given the anticipated lack of difference in other short-term outcomes (mortality, length of stay and feeding parameters), this finding represents the greatest inherent advantage of the flap closure. Recent editorials have begun to identify early exposure to general anesthesia as a potential contributor to differences in long-term neurocognitive performance [31]. While the exact magnitude of the neurotoxic effects of general anesthesia is unclear and undergoing intense study [32–34], the call for deferring, delaying or avoiding anesthesia altogether is becoming harder to ignore. Similar to the ALARA (As Low As Reasonably Achievable) principle adopted by radiologists [35], it will not be long before anesthesiologists, pediatricians and neonatologists adopt a similar mantra. Irrespective of some surgeon's current preference to use general anesthesia with flap closure, this technique represents the only reasonable method to close the abdominal defect without general anesthesia."
Reasoning: The conclusions provide an interpretation of the results in the context of other evidence and discuss implications for future practice.
[Yes]
P27. Funding
Quotes: "Acknowledgements: We are indebted to Elena Guadagno, the librarian at the Montreal Children's Hospital for her help with the literature search. We also recognize Dr. Robert A. Cusick the corresponding author at University of Nebraska Medical Center, Omaha, NE, USA for his cooperation by providing unpublished data from one of the included studies in this review [17]."
Reasoning: Sources of support for the systematic review are acknowledged, but the role of funders is not explicitly stated. Funding for the individual studies is not reported.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
0
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
1
|
0
|
0
|
0
|
NA
|
NA
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
0
|
1
|
0
|
0
|
0
|
1
|
0
|
0
|
0
|
0
|
0
|
1
|
NA
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
NA
|
NA
|
0
|
1
|
0
|
NA
|
NA
|
NA
|
NA
|
0
|
0
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
NA
|
NA
|
0
|
0
|
0
|
1
|
NA
|
NA
|
NA
|
1
|
1
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
0
|
0
|
0
|
1
|
0
|
0
|
NA
|
NA
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
0
|
0
|
0
|
0
|
0
|
0
|
NA
|
NA
|
NA
|
0
|
LLM response
10 quote(s) from
publication full text (mean similarity 94%)
A1
"After Internal Review Board approval, a prospective study was performed on all patients undergoing SIPES between March 2010 and March 2011 at our institution."
The authors mention obtaining IRB approval before conducting the study, indicating an a priori design.
[Yes]
A2
No relevant quotes found.
The authors do not mention duplicate study selection and data extraction.
[No]
A3
"Scientific databases (PubMed, OVID, ERIC, and Cochrane Collaboration) were searched using the keywords 'single port surgery' and 'child'."
The authors searched multiple databases and provided keywords, but did not supplement with other search strategies.
[No]
A4
No relevant quotes found.
The authors do not mention whether they included grey literature.
[No]
A5
No relevant quotes found.
The authors do not provide a list of included and excluded studies.
[No]
A6
"Complete medical records including full details of analgesia requirements and postoperative pain were available for 10 patients (8 males, 11 SIPES procedures) for whom all articles (2008-2012) comparing postoperative pain following transumbilical SIPES and SL in children were analyzed."
The authors provide some characteristics of included patients, but not in an aggregated form like a table.
[No]
A7
No relevant quotes found.
The authors do not describe assessing the quality of included studies.
[No]
A8
[NA]
A9
[NA]
A10
[NA]
A11
No relevant quotes found.
The authors do not report sources of funding or conflicts of interest for the included studies.
[No]
P1
"Is single incision pediatric endoscopic surgery more painful than standard laparoscopy in children? Personal experience and review of the literature"
The title identifies the article as a review of the literature.
[Yes]
P2
No relevant quotes found.
The article does not contain a structured abstract summarizing key sections.
[No]
P3
"It has been speculated that single incision pediatric endoscopic surgery (SIPES) in children could result in more postoperative pain given the device size for a child umbilicus."
The introduction provides rationale for the review in the context of speculation that SIPES may cause more pain in children.
[Yes]
P4
No relevant quotes found.
The introduction does not provide an explicit statement of the review questions and PICOS.
[No]
P5
No relevant quotes found.
The authors do not mention a review protocol or registration.
[No]
P6
No relevant quotes found.
Eligibility criteria are not clearly specified.
[No]
P7
"Scientific databases (PubMed, OVID, ERIC, and Cochrane Collaboration) were searched using the keywords 'single port surgery' and 'child'. Only comparative articles that were published between 2008 and November 2012 and that analysed postoperative pain following SIPES or SL in children were included."
Information sources and dates of coverage are described.
[Yes]
P8
No relevant quotes found.
The full search strategy is not presented.
[No]
P9
No relevant quotes found.
The study selection process is not described in detail.
[No]
P10
No relevant quotes found.
The data collection process is not described.
[No]
P11
No relevant quotes found.
Data items are not clearly defined.
[No]
P12
No relevant quotes found.
Methods for assessing risk of bias are not described.
[No]
P13
"The median number of required doses of paracetamol per patient was 5 in the SIPES group (range, 1-20) as well as in the SL group (range, 1-9; P=0·57, Table II)."
The median is reported as a summary measure.
[Yes]
P14
[NA]
P15
[NA]
P16
[NA]
P17
No relevant quotes found.
A flow diagram of study selection is not provided.
[No]
P18
No relevant quotes found.
Characteristics of individual studies are not presented.
[No]
P19
No relevant quotes found.
Risk of bias assessments for individual studies are not reported.
[No]
P20
"The median number of required doses of paracetamol per patient was 5 in the SIPES group (range, 1-20) as well as in the SL group (range, 1-9; P=0·57, Table II)."
Results for individual studies are partially reported in the text and Table II.
[Yes]
P21
[NA]
P22
[NA]
P23
[NA]
P24
"In conclusion, the present study suggests that single port laparoscopic surgery in children is feasible, safe and associated with a similar postoperative pain to standard laparoscopy."
The main findings are summarized in the discussion.
[Yes]
P25
"The eight studies that we analysed are then further supported by a series of noncomparative articles. For instance, in a retrospective review of his experience with SIPES splenectomy, cholecystectomy and appendicectomy in 20 children, Dutta reported that intravenous analgesia requirements mirrored that of SL."
Some limitations of the evidence base are discussed.
[Yes]
P26
"In conclusion, the present study suggests that single port laparoscopic surgery in children is feasible, safe and associated with a similar postoperative pain to standard laparoscopy. We agree with Iqbal and Ostlie that even if SIPES does not confer a clear advantage in terms of postoperative pain, its cosmetic circumstances it can be offered to patients and their families who are happier having a scarless umbilicus."
The discussion provides a general interpretation and suggests implications.
[Yes]
P27
No relevant quotes found.
Sources of funding for the systematic review are not reported.
[No]
PRISMA
|
|
P1
|
P2
|
P3
|
P4
|
P5
|
P6
|
P7
|
P8
|
P9
|
P10
|
P11
|
P12
|
P13
|
P14
|
|
Human Consensus
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
1
|
1
|
1
|
0
|
1
|
1
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
1
|
0
|
1
|
1
|
|
|
P15
|
P16
|
P17
|
P18
|
P19
|
P20
|
P21
|
P22
|
P23
|
P24
|
P25
|
P26
|
P27
|
|
Human Consensus
|
0
|
0
|
1
|
1
|
0
|
1
|
1
|
0
|
1
|
0
|
0
|
1
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
0
|
1
|
0
|
1
|
0
|
1
|
1
|
0
|
1
|
1
|
1
|
1
|
0
|
AMSTAR
|
|
A1
|
A2
|
A3
|
A4
|
A5
|
A6
|
A7
|
A8
|
A9
|
A10
|
A11
|
|
Human Consensus
|
0
|
0
|
1
|
0
|
0
|
1
|
0
|
0
|
1
|
0
|
0
|
|
LLM (Claude-3-Opus, 2nd run)
|
1
|
1
|
1
|
0
|
0
|
1
|
0
|
0
|
1
|
0
|
0
|
LLM response
28 quote(s) from
publication full text (mean similarity 99.7%)
A1
Quote: "The aim of this systematic review and meta-analysis was to compare clinical outcomes between single-incision laparoscopic appendicectomy and conventional laparoscopic appendicectomy in children."
Reasoning: The research question and inclusion criteria were established before conducting the review.
[Yes]
A2
Quotes: "Two authors independently extracted data from the list of the included studies, and a third reviewer was required for a final decision in the case of any discrepancies." "The primary objective of our analysis was to evaluate the operative time, length of hospital stay."
Reasoning: Two authors independently extracted data and a third reviewer resolved discrepancies.
[Yes]
A3
Quotes: "An electronic search of EMBASE, PubMed, MEDLINE was performed. Operative time, length of hospital stay, postoperative complications including wound infection, intra-abdominal infection, ileus in SILA and CLA were pooled and compared by meta-analysis." "References, reviews and meta-analyses were then scanned for additional articles."
Reasoning: At least 2 electronic databases were searched and references of retrieved articles were scanned.
[Yes]
A4
Reasoning: The authors did not mention whether they searched for reports regardless of publication type or excluded studies based on publication status.
[No]
A5
Quote: "Twelve studies (4 randomized controlled trials, 1 prospective study and 7 retrospective studies) that included 2,109 pediatric patients were studied. Of these patients, 933 and 1,176 patients had undergone SILA and CLA, respectively."
Reasoning: The number of included studies was provided but a list of excluded studies was not given.
[No]
A6
Quote: "Table 1 outlines basic demographic data for the included study, including study style, male:female sex ratio and BMI (kg/m2) or weight (kg) in each group. Table 2 displays the primary and secondary outcome results from each study."
Reasoning: Characteristics of included studies like study design, patient demographics and outcomes were provided in an aggregated form.
[Yes]
A7
Quote: "Twelve studies (4 randomized controlled trials, 1 prospective study and 7 retrospective studies) that included 2,109 pediatric patients were studied."
Reasoning: The authors mentioned the study designs of included studies but did not provide an a priori method for assessing study quality.
[No]
A8
Reasoning: Since study quality was not assessed, the results of methodological rigor could not be considered when formulating conclusions.
[No]
A9
Quotes: "A sensitivity analysis was conducted where four studies were excluded and the meta-analysis of the remaining 6 studies shown a significant increase in mean operative time in SILA (Fig. 2b)." "Statistical Heterogeneity was assessed using the Chi square test with significance set at P < 0.10. If the I2 value was less than 50 %, a fixed-effects approach was applied; if the I2 value was 50 % or more, then a random-effects approach instead of a fixed-effect analysis would be undertaken [6]."
Reasoning: Appropriate methods were used to combine findings, including assessment and handling of heterogeneity.
[Yes]
A10
Quote: "There was no evidence of statistical heterogeneity (I2 = 0 %)."
Reasoning: Publication bias was not assessed, likely because there were fewer than 10 studies, but this was not explicitly stated.
[No]
A11
Reasoning: Sources of funding or support for the systematic review and included studies were not reported.
[No]
P1
Quote: "Single-incision versus conventional laparoscopic appendicectomy in children: a systematic review and meta-analysis"
Reasoning: The title identifies the article as a systematic review and meta-analysis.
[Yes]
P2
Quote: See the structured abstract on page 1 with labeled sections for background, methods, results, and conclusion.
Reasoning: A structured summary is provided with the required sections.
[Yes]
P3
Quote: "As surgical techniques have developed and the demand for procedures that cause less pain and have better cosmetic outcome, more and more surgeons draw their attention to minimally invasive techniques. The single-incision laparoscopic appendicectomy (SILA) was first reported in 1992 and quickly became a novel member of the minimally invasive surgery [1]."
Reasoning: The rationale for the review is described in the context of what is already known.
[Yes]
P4
Quote: "The aim of this systematic review and meta-analysis was to compare clinical outcomes between single-incision laparoscopic appendicectomy and conventional laparoscopic appendicectomy in children."
Reasoning: An explicit statement of the review question is provided, referring to the participants, interventions and outcomes.
[Yes]
P5
Reasoning: The article does not mention if a review protocol exists or where it can be accessed.
[No]
P6
Quote: "Children with histologically confirmed acute appendicitis who received SILA or CLA were recruited. Inclusion criteria: (1) clinical trials that compared single-incision versus conventional laparoscopic appendicectomy between 2000 and 2014; (2) children younger than 18 years with acute appendicitis; (3) original data included some of the following: operative time, length of hospital stay, postoperative recovery, and postoperative complications. Exclusion criteria: (1) no conventional laparoscopic appendicectomy as a control; (2) chronic appendicitis; and (3) duplicate publication or study did not provide sufficient original data."
Reasoning: Study characteristics used as eligibility criteria are specified.
[Yes]
P7
Quote: "An electronic search was performed using EMBASE, PubMed, MEDLINE from 2000 to 2014. The search terms single-incision, transumbilical, three-port, conventional laparoscopic surgery, children and appendectomy were used individually and in combination. References, reviews and meta-analyses were then scanned for additional articles."
Reasoning: Electronic databases searched and the search date range are described.
[Yes]
P8
Reasoning: The full electronic search strategy is not presented such that it could be repeated.
[No]
P9
Quote: "References, reviews and meta-analyses were then scanned for additional articles. We also performed a search on Google Scholar, reviewed the references of selected studies."
Reasoning: The process for selecting studies, including screening and eligibility, is described.
[Yes]
P10
Quote: "Two authors independently extracted data from the list of the included studies, and a third reviewer was required for a final decision in the case of any discrepancies."
Reasoning: The method of data extraction is described, involving two independent reviewers and a process for resolving discrepancies.
[Yes]
P11
Quote: "The primary objective of our analysis was to evaluate the operative time, length of hospital stay. Secondary objectives included an analysis of postoperative complications including wound infection, intra-abdominal infection, and ileus."
Reasoning: The primary and secondary outcomes for which data were sought are defined.
[Yes]
P12
Reasoning: The article does not describe methods used for assessing risk of bias in individual studies.
[No]
P13
Quote: "For dichotomous variables, we used odds ratios (ORs)."
Reasoning: Odds ratios are stated as the summary measure for dichotomous outcomes.
[Yes]
P14
Quote: "Statistical Heterogeneity was assessed using the Chi square test with significance set at P < 0.10. If the I2 value was less than 50 %, a fixed-effects approach was applied; if the I2 value was 50 % or more, then a random-effects approach instead of a fixed-effect analysis would be undertaken [6]."
Reasoning: The methods for assessing heterogeneity and deciding on a fixed-effect vs random-effects model are described.
[Yes]
P15
Reasoning: The article does not mention any methods for assessing risk of bias that may affect the cumulative evidence, such as publication bias or selective reporting.
[No]
P16
Quote: "A sensitivity analysis was conducted where four studies were excluded and the meta-analysis of the remaining 6 studies shown a significant increase in mean operative time in SILA (Fig. 2b)."
Reasoning: A sensitivity analysis excluding some studies was described.
[Yes]
P17
Quote: "Twelve studies (4 randomized controlled trials, 1 prospective study and 7 retrospective studies) that included 2,109 pediatric patients were studied. Of these patients, 933 and 1,176 patients had undergone SILA and CLA, respectively."
Reasoning: The number of studies screened, included and the reasons for exclusions are not fully reported. A flow diagram is not provided.
[No]
P18
Quote: "Table 1 outlines basic demographic data for the included study, including study style, male:female sex ratio and BMI (kg/m2) or weight (kg) in each group."
Reasoning: Characteristics of each included study are presented in a table.
[Yes]
P19
Reasoning: Results of the risk of bias assessment for each study are not presented, as risk of bias was not assessed.
[No]
P20
Quotes: "Table 2 displays the primary and secondary outcome results from each study." See Tables 1 and 2 and Figures 2-6 which present the results for each outcome from individual studies.
Reasoning: For each study and outcome, summary data for each group and effect estimates with confidence intervals are presented, some in forest plots.
[Yes]
P21
Quotes: See Figures 2-6 which present forest plots with meta-analysis results and confidence intervals for several outcomes.
Reasoning: The results of each meta-analysis performed are reported with confidence intervals and measures of consistency.
[Yes]
P22
Reasoning: The article does not present any assessment of risk of bias across studies.
[No]
P23
Quote: "A sensitivity analysis was conducted where four studies were excluded and the meta-analysis of the remaining 6 studies shown a significant increase in mean operative time in SILA (Fig. 2b)."
Reasoning: The results of the sensitivity analysis are reported.
[Yes]
P24
Quote: "Although our meta-analysis reveals no significant differences in mean operative time between two groups, a sensitivity analysis revealed a significant increase in mean operative time in SILA. Therefore, it is important to note that the learning curve may play an important role in the reduction of mean operative time in SILA for surgeons."
Reasoning: The main findings are summarized, including the strength of evidence and relevance to key groups like surgeons.
[Yes]
P25
Quote: "Our systematic review and meta-analysis does have some limitations. On one hand, the overall methodologic quality and reporting of the included trials in children was poor. Some included studies had rather small sample size."
Reasoning: Limitations at the study and review level are discussed.
[Yes]
P26
Quote: "In conclusion, our study suggests that SILA is a feasible and safe surgical procedure alternative to CLA for pediatric patients with appendicitis. It reveals significantly shorter hospital stay and potential comparable operative time, postoperative complications such as wound infection, intra-abdominal infection, and ileus compared with CLA. However, most of the studies included in our meta-analysis were retrospective studies. Therefore, more prospective randomized controlled trials are needed in children to draw a more convincing conclusion."
Reasoning: A general interpretation of the results in the context of other evidence and implications for future research are provided.
[Yes]
P27
Reasoning: Sources of funding or support for the systematic review are not described.
[No]